Diagnosis and Treatment of Cirrhosis —Reply

In Reply Dr Braillon makes multiple important points about the recommendation of using hydroxyzine for sleep in patients with cirrhosis. Our Review focused on evidence-based therapies for patients with cirrhosis, and unfortunately, to date, trials of specific nonpharmacologic therapies for sleep disorders in the context of cirrhosis are lacking. However, in a recent article about contemporary management of pain in cirrhosis, we recommended nonpharmacologic interventions for sleep disorder. Sleep disorder in cirrhosis is also a complex topic with multiple contextual nuances, and the field is evolving. For example, lactulose therapy improves sleep for patients with covert hepatic encephalopathy. Following the publication of our Review, we showed that many patients with cirrhosis experienced improved sleep with use of lactulose even if they had not been diagnosed with hepatic encephalopathy.
Source: JAMA - Category: General Medicine Source Type: research