Rifaximin Improves Cognitive Performance and Reduces Cirrhosis‐Related Adverse Events in Covert Hepatic Encephalopathy: A Randomized Controlled Trial

作者：Hiroki Inada, Toshinori Toyota, Haruki Uojima, Etsuko Iio, Takao Miwa, Satoshi Miuma, Shiho Miyase, Takahiro Mizuta, Daiki Maeda, Katsuya Nagaoka, Satoshi Narahara, Sotaro Kurano, Kentaro Tanaka, Yoko Yoshimaru, Takehisa Watanabe, Shuichiro Iwasaki, Hisashi Hidaka, Kazuhiro Sugi, Hiroko Setoyama, Masahito Shimizu, Jiro Nakayama, Yasuhito Tanaka · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2026 · DOI：10.1111/apt.70712 · 被引用次数：4 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND: Covert hepatic encephalopathy (CHE) is associated with cognitive impairment and adverse clinical outcomes; however, randomized evidence supporting therapeutic intervention remains limited. AIM: To evaluate the efficacy of rifaximin (RFX) as a treatment for CHE. METHODS: In this multicentre, open-label randomized controlled trial, patients with CHE associated with liver cirrhosis were randomized (1:1) to receive RFX or no treatment and followed for 12 weeks. The primary endpoint was the change in Stroop test performance. Secondary endpoints included NCT-B scores, serum ammonia levels, cirrhosis-related adverse events, and gut microbiota composition. RESULTS: Fifty patients were randomized and completed follow-up. Stroop test performance improved significantly in the RFX group (p = 0.006) but not in controls (p = 0.400), with a trend toward greater improvement with RFX (Δ Stroop test: -4.45 ± 7.12 vs. -0.98 ± 5.74 s; p = 0.056). Among patients not receiving synthetic disaccharides at baseline, improvement was significantly greater with RFX (Δ Stroop test: -3.73 ± 5.96 vs. -0.80 ± 5.86 s; p = 0.049). No significant changes were observed in NCT-B scores or serum ammonia levels. Cirrhosis-related adverse events were significantly reduced in the RFX group (p = 0.006). Overall, gut microbial diversity did not differ between groups; however, RFX selectively altered specific taxa, including loss of the [Eubacterium] brachy group. CONCLUSIONS: RFX improved cognitive perform...