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Peer-reviewedCC BYArquivos de gastroenterologia

HEPATIC ENCEPHALOPATHY IN ALCOHOL-RELATED CIRRHOSIS:A SYSTEMATIC REVIEW OF CLINICAL CHARACTERISTICS, THERAPEUTIC STRATEGIES, AND PROGNOSTIC OUTCOMES Revisão Sistemática da Incidência, Estratégias Terapêuticas e Determinantes de Desfecho

  • Gilberto JARAMILLO-TRUJILLO1,2
  • Juan Sebastián FRÍAS-ORDOÑEZ1,3,4
  • Hernando MARULANDA-FERNANDEZ1,5,6,7,8
  • William OTERO-REGINO1,8
  • Jorge Armando MEJÍA-TOBAR9,10
10 affiliations
  1. 1National University of Colombia, Gastroenterology, Bogotá, Colombia.
  2. 2San Rafael Hospital of Facatativá, Gastroenterology, Cundinamarca, Colombia.
  3. 3International Hospital of Colombia, Gastroenterology, Bucaramanga, Colombia.
  4. 4Cardiovascular Foundation of Colombia, Research Group in Medical and Surgical Specialties, Floridablanca, Colombia.
  5. 5Central Police Hospital, Gastroenterology and Digestive Endoscopy, Bogotá, Colombia.
  6. 6Occidente de Kennedy Hospital, Gastroenterology and Digestive Endoscopy, Bogotá, Colombia.
  7. 7Santa Clara Hospital, Gastroenterology and Digestive Endoscopy, Bogotá, Colombia.
  8. 8Center for Gastroenterology and Endoscopy, Bogotá, Colombia.
  9. 9University Foundation of Health Sciences - San José Hospital, Clinical Toxicology, Bogotá, Colombia.
  10. 10Mental Health Foundation of Valle, Jamundí, Colombia.
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Abstract

Background: : Hepatic encephalopathy (HE) is a major complication of cirrhosis; however, its characterization in alcohol-related cirrhosis (ARC) remains limited because most available evidence derives from mixed-etiology cohorts.

Methods: : A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, EMBASE, and LILACS were searched through April 2026. Randomized controlled trials and cohort studies involving adults with ARC or documented alcohol consumption reporting HE-related outcomes were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool and the Newcastle-Ottawa Scale, while certainty of evidence was evaluated using the GRADE framework. Due to substantial heterogeneity, a narrative synthesis was performed.

Results: : Fourteen studies involving 6,185 participants were included. HE was associated with a hospital prevalence of 18.5% and a 90-day mortality of 12.1%. Observational evidence suggested that HE was associated with increased mortality (HR 3.1 at 90 days; HR 2.9 at 1 year), while active alcohol consumption was identified as a potential adverse prognostic factor (HR 2.5). For secondary prophylaxis, rifaximin was associated with reduced recurrence (HR 0.42), predominantly as add-on therapy to lactulose. Lactulose also reduced recurrence compared with placebo. In acute HE, polyethylene glycol demonstrated faster clinical improvement than lactulose, although evidence was limited.

Conclusion: : Available evidence suggests that HE in alcohol-related cirrhosis may represent a clinically relevant subgroup with potentially distinct prognostic characteristics. However, current evidence remains indirect, heterogeneous, and largely derived from mixed-etiology populations, precluding definitive conclusions regarding a specific alcohol-related HE phenotype. Dedicated prospective studies are needed.

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Cite

BibTeXRIS
BibTeX
@article{jaramillotrujillo2026hepatic,
  title = {{HEPATIC ENCEPHALOPATHY IN ALCOHOL-RELATED CIRRHOSIS:A SYSTEMATIC REVIEW OF CLINICAL CHARACTERISTICS, THERAPEUTIC STRATEGIES, AND PROGNOSTIC OUTCOMES Revisão Sistemática da Incidência, Estratégias Terapêuticas e Determinantes de Desfecho}},
  author = {Gilberto JARAMILLO-TRUJILLO and Juan Sebastián FRÍAS-ORDOÑEZ and Hernando MARULANDA-FERNANDEZ and William OTERO-REGINO and Jorge Armando MEJÍA-TOBAR},
  journal = {Arquivos de gastroenterologia},
  year = {2026},
  month = oct,
  doi = {10.1590/s0004-2803.24612026-066},
  url = {https://europepmc.org/article/PMC/PMC13722408},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - HEPATIC ENCEPHALOPATHY IN ALCOHOL-RELATED CIRRHOSIS:A SYSTEMATIC REVIEW OF CLINICAL CHARACTERISTICS, THERAPEUTIC STRATEGIES, AND PROGNOSTIC OUTCOMES Revisão Sistemática da Incidência, Estratégias Terapêuticas e Determinantes de Desfecho
AU  - Gilberto JARAMILLO-TRUJILLO
AU  - Juan Sebastián FRÍAS-ORDOÑEZ
AU  - Hernando MARULANDA-FERNANDEZ
AU  - William OTERO-REGINO
AU  - Jorge Armando MEJÍA-TOBAR
PY  - 2026
DA  - 2026/10/30
JO  - Arquivos de gastroenterologia
DO  - 10.1590/s0004-2803.24612026-066
UR  - https://europepmc.org/article/PMC/PMC13722408
AB  - Background: : Hepatic encephalopathy (HE) is a major complication of cirrhosis; however, its characterization in alcohol-related cirrhosis (ARC) remains limited because most available evidence derives from mixed-etiology cohorts.  Methods: : A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, EMBASE, and LILACS were searched through April 2026. Randomized controlled trials and cohort studies involving adults with ARC or documented alcohol consumption reporting HE-related outcomes were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool and the Newcastle-Ottawa Scale, while certainty of evidence was evaluated using the GRADE framework. Due to substantial heterogeneity, a narrative synthesis was performed.  Results: : Fourteen studies involving 6,185 participants were included. HE was associated with a hospital prevalence of 18.5% and a 90-day mortality of 12.1%. Observational evidence suggested that HE was associated with increased mortality (HR 3.1 at 90 days; HR 2.9 at 1 year), while active alcohol consumption was identified as a potential adverse prognostic factor (HR 2.5). For secondary prophylaxis, rifaximin was associated with reduced recurrence (HR 0.42), predominantly as add-on therapy to lactulose. Lactulose also reduced recurrence compared with placebo. In acute HE, polyethylene glycol demonstrated faster clinical improvement than lactulose, although evidence was limited.  Conclusion: : Available evidence suggests that HE in alcohol-related cirrhosis may represent a clinically relevant subgroup with potentially distinct prognostic characteristics. However, current evidence remains indirect, heterogeneous, and largely derived from mixed-etiology populations, precluding definitive conclusions regarding a specific alcohol-related HE phenotype. Dedicated prospective studies are needed.
SN  - 0004-2803
SN  - 1678-4219
ER  -