Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes.
Population: Adults with cirrhosis (mean age 41 to 61 years)
Intervention: Non‐absorbable disaccharides (lactulose or lactitol) ᵃ
Comparison: Placebo or no intervention
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Mortality (follow‐up up to 7 months) | Favours intervention | Moderate |
Hepatic encephalopathy (follow‐up up to 7 months) | Favours intervention | Moderate |
Serious adverse events (follow‐up up to 7 months) | Occurs more commonly with placebo or no intervention compared with disaccharides (favours intervention) | Moderate |
Quality of life (follow‐up up to 3 months): sickness impact profile - change from baseline | Favours intervention ᵇ | Very Low |
Quality of life (follow‐up up to 3 months): sickness impact profile - end of treatment | No statistically significant difference | Very Low |
Non‐serious adverse events: overall ᶜ | Occurs more commonly with disaccharides compared with placebo or no intervention (favours comparison) | Very Low |
Note ᵃ Treatment duration was dependent on type of encephalopathy (mean duration: 5 days for acute; 74 days for chronic, 70 days for minimal and 207 days for the prevention of hepatic encephalopathy). ᵇ This outcome was only reported in studies of lactulose versus placebo. ᶜ A statistically significant difference between treatment groups favouring placebo or no treatment was found for two subgroups (diarrhoea and bloating) while disaccharides was favoured for a third subgroup (constipation). GRADE assessment was not performed for any of these subgroups. Trials assessing other outcomes (nausea, hyponatraemia, anal fissure, and hyperglycaemia) were underpowered.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does band ligation compare with no intervention for adults with cirrhosis and esophageal varices in preventing upper gastrointestinal bleeding?
- For adults with decompensated liver cirrhosis, how do treatments for ascites compare?
- How do portosystemic shunts compare with endoscopic interventions for prevention of rebleeding in adults with cirrhosis?
- In people with cirrhosis and upper gastrointestinal bleeding, how does antibiotic prophylaxis affect outcomes?
- Can non-absorbable disaccharides help to prevent or treat hepatic encephalopathy in people with cirrhosis?
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