Allopurinol to Prevent Cirrhosis Related Morbidities

Study Overview
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Brief Summary
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The study aims to compare the potential benefit of allopurinol in reducing the risk of developing cirrhosis-related complications, delaying the onset of hepatocellular carcinoma, and improving survival. Furthermore, the study aims to evaluate their impact on parents' related quality of life

Detailed Description
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Cirrhosis is the late stage of liver damage and possess two phases: a compensated phase with favorable prognosis and a decompensated phase with high mortality rate.The shift from compensated to decompensated cirrhosis is characterized by the onset of complications, including ascites, hepatic encephalopathy (HE), variceal bleeding, and spontaneous bacterial peritonitis (SBP) which are associated with substantial morbidity and negative Impact on quality of life (QOL). The gut microbiota plays an important role in cirrhosis and development of cirrhosis-related complications. Indeed, translocation of endotoxins is increased in patients with cirrhosis and patients with more severe cirrhosis (i.e. Patients with decompensated cirrhosis, hospitalized patients) had significantly greater serum endotoxin concentrations that mediate complications of cirrhosis. Intestinal permeability plays a role in the development of bacterial translocation and may be involved in the development of complications of cirrhosis. This 'leaky gut' phenomenon increases with the degree of liver failure and is particularly prominent in patients with cirrhosis who have experienced severe septic complications and has been implicated in the hepatic production of endotoxin-associated proinflammatory cytokines. Intestinal mucosa alterations at the subcellular level have been reported in experimental cirrhosis, in relation to an increased oxidative stress due to overactivity in the enzyme xanthine oxidase. Allopurinol, a competitive xanthine oxidase inhibitor, reduces oxidative stress and attenuates bacterial translocation in portal hypertensive animals, suggesting that the damaging effects of oxygen-derived free radicals and peroxidation on mucosal cells may be counteracted by a free radical scavenger. In 2007, a pilot study demonstrated that allopurinol in patients with cirrhosis is associated with a significant reduction in oxidative stress but no effect on intestinal permeability and inflammatory markers. The study duration was only 10 days and therefore another study with a long period of time is essential.

Official Title
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Allopurinol Impact on Cirrhosis Related Complications

Conditions
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Cirrhosis

Intervention / Treatment
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* Drug: Placebo
* Drug: Allopurinol 300 MG


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ge 18 to 75 years old Both sex Adults with cirrhosis in a stable conditions Exclusion Criteria: Active SBP Renal insufficiency (serum creatinine > 2.0 mg/dl) Active GIT hemorrhage

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: placebo<br>Group1: (Placebo, n=50) who will receive oral placebo tablet once daily FOR 6 MONTHS | Drug: Placebo<br>* not containing drugs<br>|
| Active Comparator: allopurinol<br>Group 2:(Allopurinol n=50) who will receive oral allopurinol 300 mg daily for 6 months | Drug: Allopurinol 300 MG<br>* a competitive xanthine oxidase inhibitor, reduces oxidative stress and attenuates bacterial translocation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| morbidities | occurrence or exacerbation of complication | 6 moths |