Role of Bowel Wash and Gut-Sterilization in Recovery from Hepatic Encephalopathy: A Prospective Observational Study from a Tertiary Centre in Central India

Background: Hepatic encephalopathy (HE) is a major complication of advanced liver disease; gut-directed strategies such as bowel wash and gut-sterilization are used to hasten neurological recovery. Material and Methods: We conducted a prospective observational study for one year at the Department of Medicine, Gandhi Medical College, and associated Hamidia Hospital, Bhopal. Adults admitted with the West Haven criteria staged him. Interventions comprised bowel wash and gut-sterilization administered at frequencies tailored to HE stages. The primary endpoint was improvement/time to recovery; secondary endpoints were in-hospital outcomes. Sample size was n=100; IEC approval and informed consent were obtained. Results: Baseline HE stages were: stage 1, 9% (n=9); stage 2, 54% (n=54); stage 3, 34% (n=34); stage 4, 3% (n=3). Most patients received 3–4 bowel washes/day (83%); 13% received 2–3/day and 4% received 4–5/day. Mean time to recovery increased with HE stages: 1.89 (stage-1), 3.79 (stage-2), 5.97 (stage-3), 12.00 days (stage-4); P < 0.001. Outcomes varied by stage (P < 0.001): stage-1 all recovered (n=9); stage-2 recovered 52, LAMA 2; stage-3 recovered 28, LAMA 3, deaths 3; stage-4 recovered 1, deaths 2 (totals: recovered 90, LAMA 5, deaths 5). Conclusion: In this tertiary-care cohort, bowel wash with gut-sterilization was associated with clinically meaningful recovery across HE stages, with faster recovery in lower stages and a clear gradient in outcomes by severity. These findings support gut-directed therapy as a practical component of HE management and motivate optimizing the protocol's frequency and duration. Keywords: Hepatic encephalopathy; bowel wash; gut-sterilization; West Haven stages; recovery time; tertiary care India.