Efficacy of lactulose in the prophylaxis of hepatic encephalopathy in cirrhotic patients presenting gastrointestinal bleeding

Abstract

Administering lactulose to cirrhotic patients with upper gastrointestinal bleeding reduces the incidence of hepatic encephalopathy.

EASL Clinical Practice Guidelines on the management of hepatic encephalopathy

“…118 The meta-analysis of those 2 trials confirmed the beneficial effect of lactulose on the prevention of HE during gastrointestinal bleeding (7% vs. 28%, p <0.01), though it was not associated with any survival benefit. 119 Mannitol by mouth has also been shown to work in this context, also by comparison with paromomycin plus lactulose. 120,121 In patients with gastrointestinal bleeding, broadspectrum antibiotic prophylaxis also had a beneficial effect on survival, especially in patients with Child-Pugh C cirrhosis.…”

A Study on the Role of Lactulose on Hepatic Encephalopathy Among Cirrhotic Patients with Acute Upper Gastrointestinal Bleeding

“…The recommended course of action is still to address the precipitating factor prophylactically in high-risk circumstances to prevent HE due to the substantial morbidity and mortality that are linked with it. 19 Within a few hours of the start of GI bleeding, the amount of blood urea nitrogen rises and peaks 24 to 48 hours later. Therefore, remaining blood in the GI tract can result in significant ammonia production.…”

Hepatic encephalopathy: Diagnosis and management

“…Aside from indicating greater activity of polyetilenglycole per se, which is unlikely as it has only an osmotic cathartic effect and not also a prebiotic/acidifying effect , these studies highlight that catharsis should be as quick as possible. In line with this interpretation, studies have reported the efficacy of gut lavage using large oral volumes of mannitol and other osmotic cathartics for primary prophylaxis of HE after upper gastrointestinal bleeding . Despite limited application for the lower part of the colon‐rectum, the use of non‐absorbable disaccharide enemas have been proven to be effective for obtaining rapid catharsis and superior to enemas using a large amount of water to treat HE .…”

“… Individuals who have upper gastrointestinal bleeding are at risk for overt HE. Precocious gastrointestinal lavage by mannitol or non‐absorbable disaccharides reduces the risk for overt HE Any treatment for cirrhosis that may reduce or revert the progression of disease may be considered primary prophylaxis for HE, for instance, alcohol abstinence in alcohol misusers, antiviral drugs in virus‐related cirrhosis, proper nutrition in malnourished patients (both excess and deficiency), and iron overload, among others. …”

“…In line with this interpretation, studies have reported the efficacy of gut lavage using large oral volumes of mannitol 46,47 and other osmotic cathartics for primary prophylaxis of HE after upper gastrointestinal bleeding. 48 Despite limited application for the lower part of the colon-rectum, the use of non-absorbable disaccharide enemas have been proven to be effective for obtaining rapid catharsis and superior to enemas using a large amount of water to treat HE. 49 They are no better than neomycin and starch enemas, 50 and no studies have reported that they are preferable to any other kind of sugar or saline solutions.…”