Source Digestive Disease Division, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45267-0595, USA. neffgw@ucmail.uc.edu

Noncompliance with treatment protocols produces an increased burden on the health care system. Reports show that 23% of annual admissions to nursing homes in the United States (380,000 patients) are due to noncompliance, resulting in overall costs of over $31 billion. More than 10% of all patients (3.5 million) are hospitalized each year due to complications related to noncompliance, with over $15 billion spent. In addition, nearly half of the 2 billion prescriptions filled each year are not taken correctly. Patients with cirrhosis and hepatic encephalopathy who are prescribed lactulose experience a greater frequency of adverse effects, require more hospitalizations, and suffer more disease recurrence than those prescribed rifaximin.