Treatment of hepatic encephalopathy: Authors' reply

doi:10.1136/bmj.329.7457.112-a

BMJ 2004;329:112 (10 July), doi:10.1136/bmj.329.7457.112-a

Letter

Treatment of hepatic encephalopathy

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—We do not agree that our Cochrane review clearlyshows that lactulose is ineffective. The fact that we foundno evidence of effect does not imply that there is evidenceof no effect.¹ It is difficult to prove that a treatment hasno effect.¹

A survey of 989 abstracts of Cochrane reviews showed that inappropriateclaims of no effect were made in 240 (22.5%) abstracts.² Inour review, we found that high quality trials found no significanteffect of lactulose on the risk of no improvement of hepaticencephalopathy (relative risk 0.92, 95% confidence interval0.42 to 2.04). The confidence interval indicates that we cannotexclude that lactulose may benefit (reduce the risk of no improvementby up to 58%). On the other hand, lactulose may also harm (increasethe risk of no improvement by up to 104%). Our meta-analysisis based on only two trials with a . . . [Full text of this article]

Bodil Als-Nielsen, research fellow

Bodil.a@ctu.rh.dk

Lise L Gluud, research fellow, Christian Gluud, chief physician

Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Department 7102, H:S Rigshospitalet, DK-2100 Copenhagen, Denmark

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