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

Abstract

Aim: To determine the efficacy of lactulose as prophylaxis on hepatic encephalopathy among cirrhotic patients of acute upper gastrointestinal bleeding. Material and methods: We carried out this randomized control trial in multi centers including Mian Rashid Hussain Shaheed Memorial Hospital Pabbi Nowshera. KPK and Isra University Hospital, Hyderabad from February 2022 to July 2022 (06 months) with total no of 80 patients. Group A patients received lactulose while group B patients received sweet syrup placebo. Both groups were assessed for Hepatic encephalopathy as primary outcome. Chi Square test was used for assessment of outcomes between both groups keeping P value < 0.05 as statistically significant. Results: Eighty patients were divided into two groups equally using lottery method. Group A patients received lactulose treatment while group B patients received placebo. The mean age in group A was 44.36±15.37 years while the mean age in group B was 38.71±18.56 years. Hepatic encephalopathy was observed in 2.5% patients in group A while in group B 10% patients had HE, the difference was statistically significant. Diarrhea, abdominal pain and mortality between both groups were no statistically significant. Conclusion: Lactulose is effective in preventing hepatic encephalopathy in patients with cirrhosis and an acute upper gastrointestinal bleeding. Keywords: Lactulose, hepatic encephalopathy, cirrhosis, acute upper gastrointestinal bleeding

Prophylactic Lactulose Therapy in Patients with Cirrhosis and Upper Gastrointestinal Bleeding: A Meta-analysis of Randomized Trials

“…Overall, our review yielded five randomized trials that evaluated the effect of lactulose for the prevention of overt HE in the setting of AUGIB. All the trials [6][7][8][9] except for one [2] reported a significantly lower incidence of precipitated HE, translating into a RR of 0.38 (0.23-0.62). For the outlier study by Rattanasupar et al [2] it is important to note that the study protocol allowed for the use of an additional rescue laxative with lactulose in cases of inadequate bowel movement, which might have influenced the results.…”

“…Manual searching of reference lists of the included studies was also undertaken to ensure that no potentially relevant items were overlooked. The study methodology was designed and executed to adhere to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines [8].…”

“…1 shows the flowchart for the study selection and inclusion. Based upon our search and selection criteria, five randomized trials were identified, of which four originated from Asia [2,[6][7][8] and one from South America [9]. The characteristics of the individual studies are shown in Table I.…”

“…The characteristics of the individual studies are shown in Table I. All the trials compared lactulose against a placebo, with three trials being double-blind [2,8,9] and two as open-label [6,7]. The etiology of liver disease was specified in three studies, with alcohol being the predominant etiology in two [7,9] and hepatitis B in one [6].…”

“…The incidence of diarrhea varied from 3.8% to 54.5% in the included studies. The study by Khan et al [8] being a significant outlier, was excluded from final analysis of diarrhea incidence.…”