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Rifaximin Improves Cognitive Performance and Reduces Cirrhosis-Related Adverse Events in Covert Hepatic
Hiroki Inada1, Toshinori Toyota1, Haruki Uojima1,2
1Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Alimentary Pharmacology & Therapeutics
|May 6, 2026
Summary
Rifaximin (RFX) improved cognitive function in patients with covert hepatic encephalopathy (CHE) and reduced adverse events. The Stroop test effectively measured treatment response in this randomized trial.
Area of Science:
- Gastroenterology and Hepatology
- Neurology
- Microbiology
Background:
- Covert hepatic encephalopathy (CHE) presents with cognitive impairment and poor outcomes.
- Limited randomized evidence exists for therapeutic interventions in CHE.
- Rifaximin (RFX) is being investigated for its potential to treat CHE.
Purpose of the Study:
- To assess the efficacy of rifaximin (RFX) in treating covert hepatic encephalopathy (CHE).
- To evaluate RFX's impact on cognitive performance, ammonia levels, adverse events, and gut microbiota.
Main Methods:
- A multicenter, open-label randomized controlled trial was conducted.
- Patients with CHE and liver cirrhosis received either RFX or no treatment for 12 weeks.
- Primary endpoint: change in Stroop test performance; secondary endpoints: NCT-B scores, ammonia, adverse events, and microbiota.
Main Results:
- Rifaximin significantly improved Stroop test performance compared to controls (p=0.006).
- A trend towards greater improvement was observed with RFX, particularly in patients not on disaccharides (p=0.049).
- RFX reduced cirrhosis-related adverse events (p=0.006) but did not significantly alter NCT-B scores or ammonia levels.
Conclusions:
- Rifaximin demonstrates efficacy in improving cognitive function in CHE patients, as measured by the Stroop test.
- RFX treatment led to a significant reduction in cirrhosis-related adverse events.
- The Stroop test is a sensitive measure for evaluating treatment response in CHE.
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