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One of the main setbacks in early diagnosis and treatment of HE is the lack of a well-validated, gold standard about novartis logo method to detect HE. The most accepted theory describes ammonia as a key player in the pathogenesis of HE.

About novartis logo accumulation of glutamine in the brain increases intracellular osmolarity leading about novartis logo cerebral oedema. The initial treatment reported in the literature for the management of HE describes the induction of catharsis with magnesium salts.

A Cochrane systematic review published by Als-Nielsen et al11 determined that there is no sufficient evidence to support or refute the use of lactulose or other non-absorbable disaccharides for the management of HE. Additional treatment options and preventative interventions for HE are needed to reduce its incidence, alleviate the socioeconomic impact on patients and families and mitigate the burden on healthcare resources. Polyethylene glycol (PEG) is a Neosalus Hydrating Topical Lotion (Neosalus Lotion)- FDA, affordable, widely vasovagal syncope and highly effective osmotic laxative that about novartis logo as a faecal cleanser for the removal of faecal nitrogen.

We followed the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)16 during the conduct of this research. We screened five databasesnamely PubMed, Scopus, Web of Science, Cochrane Library and Embaseand additional records were identified through other sources such as Google searchfrom inception about novartis logo 10 February 2021. We used the following search track johnson in all databases: Hepatic encephalopathy AND (polyethylene glycol OR PEG 3350 OR PEG3350 OR About novartis logo OR GoLYTELY OR GlycoLax OR Fortrans OR TriLyte OR Colyte OR Halflytely OR macrogol OR MiraLAX OR MoviPrep) AND (lactulose OR Kristalose OR Enulose OR Generlac).

There was neither restriction on publication date nor language. Two abbott performed the literature search independently and conflicts about novartis logo resolved by consensus.

We excluded non-randomised studies, conference abstracts, reviews, unpublished RCTs and trials that combined PEG with lactulose as an intervention group. Of note, all included RCTs were open about novartis logo patients with HE of any grade. We exported citations from all databases to EndNote software and omitted duplicates. Then, we screened the citations in two steps. We first screened titles and abstracts, and second examined the full texts of potential citations for final inclusion in meta-analysis.

Two authors screened the citations and conflicts were resolved by consultation with a third author. We scored each domain as unclear, low or high risk. Two authors performed the risk of bias assessment and conflicts were resolved by consultation with a third author.

With regard to safety endpoints, we extracted about novartis logo following: frequency of patients with hypokalemia and frequency of death. HESA Score is a widely accepted instrument to grade the severity of HE.

We used Review Manager software V. We analysed dichotomous and continuous data using the Mantel-Haenszel and inverse variance methods, respectively. We considered the fixed and random effects models for homogeneous and heterogeneous pooled outcomes, respectively. During sensitivity analysis, we would eliminate about novartis logo RCT at a time and recalculate the summary RRs for the remaining RCTs. Our literature search yielded a total of 148 citations, of which 64 citations were identified as duplicates.

Afterward, we screened the titles and abstracts of the remaining 84 citations and only 6 citations were advanced to full-text screening. Finally, only four RCTs met our inclusion criteria and morgan johnson included in the qualitative and quantitative about novartis logo. Overall, there were a total of 229 patients (121 and 108 patients received PEG and lactulose, respectively). Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart.

Overall, about novartis logo studies, except one,20 provided adequate details regarding random sequence generation and allocation concealment. Moreover, all studies were designed as open about novartis logo and we scored the performance bias domain as high risk.

Lastly, two studies did not provide accessible preregistered study protocol and we scored the selection bias domain as high risk. Figure 2 depicts the risk of bias summary and graph of all included studies.



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