<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD v1.3 20210610//EN" "JATS-archivearticle1-3.dtd">
<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JPSIM</journal-id>
      <journal-title-group>
        <journal-title>Journal of Pakistan Society of Internal Medicine</journal-title>
        <abbrev-title>J Pak Soc Intern Med</abbrev-title>
      </journal-title-group>
      <issn publication-format="print">2709-8729</issn>
      <issn publication-format="electronic">2710-0804</issn>
      <publisher>
        <publisher-name>Pakistan Society of Internal Medicine</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.70302/jpsim.v6i4.2569</article-id>
      <article-id pub-id-type="publisher-id">jpsim.v6i4.2569</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Research</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Polyethylene Glycol in the Treatment of Hepatic Encephalopathy in patients with Liver Cirrhosis</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author" corresp="yes">
          <name>
            <surname>Khan</surname>
            <given-names>Kamran Amir</given-names>
          </name>
          <email>kkhan@nwgh.pk</email>
          <xref ref-type="aff" rid="aff1"/>
          <xref ref-type="corresp" rid="cor1">*</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Qureshi</surname>
            <given-names>Sameed Ullah</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Khan</surname>
            <given-names>Zuhra Naheed</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <institution>Northwest General Hospital and Research Center, Peshawar</institution>
      </aff>
      <aff id="aff2">
        <institution>Pakistan kidney and liver institute, Lahore</institution>
      </aff>
      <author-notes>
        <corresp id="cor1">*Correspondence: Kamran Amir Khan (kkhan@nwgh.pk)</corresp>
      </author-notes>
      <pub-date date-type="pub" publication-format="electronic" iso-8601-date="2025-11-21">
        <day>21</day>
        <month>11</month>
        <year>2025</year>
      </pub-date>
      <pub-date date-type="collection" publication-format="electronic">
        <year>2025</year>
      </pub-date>
      <volume>6</volume>
      <issue>4</issue>
      <fpage>373</fpage>
      <lpage>375</lpage>
      <history>
        <date date-type="received" iso-8601-date="2024-04-11">
          <day>11</day>
          <month>04</month>
          <year>2024</year>
        </date>
        <date date-type="rev-recd" iso-8601-date="2025-06-14">
          <day>14</day>
          <month>06</month>
          <year>2025</year>
        </date>
        <date date-type="accepted" iso-8601-date="2025-10-10">
          <day>10</day>
          <month>10</month>
          <year>2025</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>Copyright © 2025 The Author(s)</copyright-statement>
        <copyright-year>2025</copyright-year>
        <copyright-holder>The Author(s)</copyright-holder>
        <ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/>
        <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
          <ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
          <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <self-uri xlink:href="https://psimj.com/article/jpsim.v6i4.2569" content-type="text/html"/>
      <self-uri xlink:href="https://psimj.com/article/jpsim.v6i4.2569.pdf" content-type="application/pdf"/>
      <abstract>
        <sec>
          <title>Objective</title>
          <p>This study aims to determine the effectiveness and safety of polyethylene glycol (PEG) in patients with hepatic encephalopathy.</p>
        </sec>
        <sec>
          <title>Methodology</title>
          <p>This cross-sectional study was conducted at Northwest General Hospital and Research Centre, Peshawar, Pakistan. All patients participated in this study were diagnosed with hepatic encephalopathy from January 2019 to August 2021. All patients were given 3 sachets of polyethylene glycol daily. Recovery days, length of hospital stay, and recurrent episodes were assessed.</p>
        </sec>
        <sec>
          <title>Results</title>
          <p>A total of 75 patients with different hepatic diseases admitted to the hospital due to hepatic encephalopathy were given 3 sachets of polyethylene glycol daily. On average, 2.81 days for recovery and 5 days of hospital stay were required. The mean number of recurrent hepatic encephalopathy episodes was 0.52.</p>
        </sec>
        <sec>
          <title>Conclusion</title>
          <p>Polyethylene glycol is considered effective and safe in patients with hepatic encephalopathy, with short recovery days, hospital stay, and few recurrent episodes.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="en" kwd-group-type="author-keywords">
        <title>Keywords</title>
        <kwd>Hepatic encephalopathy</kwd>
        <kwd>polyethylene glycol</kwd>
        <kwd>liver cirrhosis.</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <!-- <body> omitted: no manuscript (.docx) on file -->
  <back>
    <notes notes-type="ethics-statement">
      <title>Ethics Statement</title>
      <p>Ethics committee: Ethics Committee, Northwest General Hospital and Research Centre, Peshawar, Pakistan. Approval number: NWGH/EC/14, dated October 04, 2021.</p>
    </notes>
    <ref-list>
      <title>References</title>
      <ref id="ref1">
        <label>1</label>
        <mixed-citation>Rudler M, Weiss N, Bouzbib C, Thabut D. Diagnosis and management of hepatic encephalopathy. Clin Liver Dis. 2021;25(2):393-417.</mixed-citation>
      </ref>
      <ref id="ref2">
        <label>2</label>
        <mixed-citation>Weiss N, Jalan R, Thabut D. Understanding hepatic encephalopathy. Inten Care Med. 2018;44:231-4.</mixed-citation>
      </ref>
      <ref id="ref3">
        <label>3</label>
        <mixed-citation>Butterworth RF, Layrargues GP. Hepatic Encephalopathy: Pathophysiology and Treatment. Springer Science &amp; Business Media; 2012; ISBN: 1461245060, 9781461245063</mixed-citation>
      </ref>
      <ref id="ref4">
        <label>4</label>
        <mixed-citation>Tsoris A, Marlar CA. Use of the Child Pugh score in liver disease. StatPearls Publishing, Treasure Island (FL). 2023;PMID: 31194448.</mixed-citation>
      </ref>
      <ref id="ref5">
        <label>5</label>
        <mixed-citation>Salerno F, Merli M, Cazzaniga M, Valeriano V, Rossi P, Lovaria A, et al. MELD score is better than Child–Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36(4):494-500.</mixed-citation>
      </ref>
      <ref id="ref6">
        <label>6</label>
        <mixed-citation>European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy. J Hepatol. 2022;77(3):807-24.</mixed-citation>
      </ref>
      <ref id="ref7">
        <label>7</label>
        <mixed-citation>Fallahzadeh MA, Rahimi RS. Hepatic Encephalopathy: Current and Emerging Treatment Modalities. Clin Gastroenterol Hepatol. 2022;20(8):S9-19.</mixed-citation>
      </ref>
      <ref id="ref8">
        <label>8</label>
        <mixed-citation>Jalan R, Rose CF. Heretical thoughts into hepatic encephalopathy. J Hepatol. 2022; 77(2):539-48.</mixed-citation>
      </ref>
      <ref id="ref9">
        <label>9</label>
        <mixed-citation>Li M, Zhang Z, Chen Q, Zhou X, Shui D, Huang J. Comparative effectiveness and safety of polyethylene glycol electrolyte solution versus lactulose for treatment of hepatic encephalopathy: a systematic review and meta-analysis. J Clin Gastroenterol. 2022;56(1):41.</mixed-citation>
      </ref>
      <ref id="ref10">
        <label>10</label>
        <mixed-citation>Sawhney R, Jalan R. The gut is a key target of therapy in hepatic encephalopathy. Nat Rev Gastroenterol Hepatol. 2015;12(1):7-8.</mixed-citation>
      </ref>
      <ref id="ref11">
        <label>11</label>
        <mixed-citation>Rahimi RS, Singal AG, Cuthbert JA, Rockey DC. Lactulose vs polyethylene glycol 3350-electrolyte solution for treatment of overt hepatic encephalopathy: the HELP randomized clinical trial. JAMA Int Med. 2014;174(11):1727-33.</mixed-citation>
      </ref>
      <ref id="ref12">
        <label>12</label>
        <mixed-citation>Shehata HH, Elfert AA, Abdin AA, Soliman SM, Elkhouly RA, Hawash NI, Soliman HH. Randomized controlled trial of polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy. Eu J Gastroenterol Hepatol. 2018;30(12):1476-81.</mixed-citation>
      </ref>
      <ref id="ref13">
        <label>13</label>
        <mixed-citation>Rose CF, Amodio P, Bajaj JS, Dhiman RK, Montagnese S, Taylor-Robinson SD, et al. Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy. J Hepatol. 2020;73(6):1526-47.</mixed-citation>
      </ref>
      <ref id="ref14">
        <label>14</label>
        <mixed-citation>Raja WJ, Sebastian B, Mathai SK. To compare the effect of polyethylene glycol vs. lactulose in the treatment of overt hepatic encephalopathy. Hepatol Gastroint Dis. 2019;5:166.</mixed-citation>
      </ref>
      <ref id="ref15">
        <label>15</label>
        <mixed-citation>Hoilat GJ, Ayas MF, Hoilat JN, Abu-Zaid A, Durer C, Durer S, et al. Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis. BMJ Open Gastroenterol. 2021;8(1):e000648.</mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>
