Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy

Abstract

Seventy-five cirrhotic patients with hyperammonemia in ing number of patients with compensated or noncompenthe past or at the time of the study were randomly divided sated cirrhosis are managed in outpatient clinics over a long into two groups (treated with lactulose or nontreated) in 14 period. In these patients, prevention of the above complicahospitals in Japan. Thirty-six cirrhotic patients were diag-tions is necessary in long-term home care to improve the nosed as having subclinical hepatic encephalopathy (SHE), quality of life (QOL). and 39 were diagnosed as non-SHE. SHE was diagnosedIn hepatic encephalopathy, psychoneurological symptoms when the results of all three of the quantitative psychometric are clinically absent before the onset and during the interval tests used (number connection test, and symbol digit and period of encephalopathic episodes. However, subclinical heblock design tests of the Wechsler adult intelligence scale patic encephalopathy (SHE), in which behavior abnormali-[revised]) were abnormal as compared with age-matched ties and impairment in cognitive functions can be shown by normal values. The mean number of abnormal psychometric quantitative psychometric (neuropsychologic) tests, has been test results and the prevalence of SHE were used for a quanti-reported recently in cirrhotic patients who have no history tative evaluation of the efficacy of the lactulose treatment. of encephalopathy, and clinically appear to be free of encephTwenty-two of the SHE patients were treated with lactulose alopathy.1,2 Moreover, recent imaging analysis of the brain (45 mL/d) for 8 weeks, and the other 14 SHE patients did in cirrhotic patients with and without encephalopathy has not receive lactulose. In the SHE patients administered lactu-shown brain atrophy on computed tomography, 3 abnormal lose, the results of the quantitative psychometric evaluation regional cerebral blood flow on single photon emission comwere significantly improved at 4 and 8 weeks after the begin-puted tomography, 4 and high signals in the basal ganglia on ning of the lactulose administration. The SHE had disap-T1-weighted magnetic resonance imaging. Therefore, it is important for the long-term management it persisted in 11 (85%) of the untreated 13 patients. We of cirrhotic patients to understand the presence of these morconcluded that lactulose treatment in cirrhotic patients with phological changes and functional impairments of the brain, SHE is effective with respect to psychometric tests. (HEPA-and to pay attention to changes in daily behavior and sleep. TOLOGY 1997;26:1410-1414.)This approach would be useful for maintaining the compensated stage of cirrhosis over a long period and for reversing Because the treatment for complications of cirrhosis such as hepatic encephalopathy, jaundice, ascites, and gastrointes-the noncompensated cirrhosis to compensated cirrhosis. tinal bleeding has improved, the survival period of cirrhotic Lactulose has been used worldwide for the treatment of patients has been markedly prolonged. Th...

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

“…On the basis of the results of 3 previous published studies, including one of ours, we estimated an average improvement of 15% in MHE in the control group and an average improvement of 75% in MHE in the treatment group. 21,22,35 Our previous data shows that the prevalence of MHE was 62.4% and 65% and that approximately 15% patients were lost to follow-up. 9,22 Therefore, approximately 26 patients were required in each arm, and it was necessary to enroll a total of 80-90 patients with cirrhosis in order to have the desired number of patients in each arm.…”

“…[15][16][17] Therapeutic interventions that aim to reduce ammonia are also useful in this setting. [18][19][20][21][22][23][24] Most studies have shown improvement in psychomotor functions coupled with a reduction in ammonia level. Improvement in cognitive functions may translate into improvement in HRQOL.…”

Management of Covert Hepatic Encephalopathy

“…Therefore, lactulose was deemed to be effective in the primary prevention of overt hepatic encephalopathy. 25 Congruent with prior results, several other studies have reported an improvement in neuropsychometric tests with various doses and durations of lactulose and lactitol treatment [25][26][27][28][29][30] (Table 1).…”

“…25,28,33,34 In a trial of 128 cirrhotic patients, Kalaitzakis et al reported that daily lactulose had a negative impact on HRQoL. 35 The laxative effect and titration to 2-3 soft bowel movements per day make adherence to lactulose classically low.…”

204 Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review of randomised trials

“…5 6 20-23 30 36 39 Lactulose or lactitol v placebo or no intervention Ten trials with 280 patients (75% men) assessed lactulose or lactitol versus placebo or no intervention (table 1). [20][21][22][23][24][25][26][27][28][29] All patients had cirrhosis and acute, 25 chronic, 20 22-24 acute or chronic, 21 or minimal hepatic encephalopathy. [26][27][28][29] Eight trials assessed oral lactulose, 20-24 26 28 29 one assessed oral lactitol, 27 and one assessed lactitol enemas.…”