Lactitol vs. lactulose in the treatment of chronic recurrent portal-systemic encephalopathy

Heredia, D.; Terés, J; Orteu, Nuria; Rodés, Juan

doi:10.1016/s0168-8278(88)80513-0

Cited by 30 publications

(13 citation statements)

References 12 publications

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“…[15][16][17][18][19][20][21][22][23] Of these, five evaluated the effect of lactulose, [19][20][21][22][23] two of synbiotics 15,16 and two of probiotics 17,18 on MHE. Eight potentially relevant trials were identified which used lactitol, however, they were excluded either because comparison was not with a placebo, but with an antibiotic 24,25 or different doses of lactitol, 26 or lactulose [27][28][29][30][31] or included patients with OHE. 31 Four controlled trials with lactulose were excluded because either they did not report the outcome of interest (number of patients that improved or worsened with treatment 32 but only mean change in the psychometric tests) or involved patients with OHE 33 or were not placebo controlled (compared with fructo-oligosaccharides 34 ) or was not an RCT.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

Shukla

Mehboob

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

176

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Section: Resultsmentioning

confidence: 99%

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

Shukla

Mehboob

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

176

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“…The median duration of treatment was 15 days (range 5-360 days). Lactitol has also been used in treatment of HE and meta-analysis showed no statistical differences in percentage of improved patients after lactitol or lactulose while slightly higher frequency of flatulence in patients treated with lactulose compared with lactitol [15][16][17][18][19] (Table 1).…”

Section: Clinical Efficacy Of Non-absorbable Disaccharidesmentioning

confidence: 99%

Management of Overt Hepatic Encephalopathy

Sharma

2015

Journal of Clinical and Experimental Hepatology

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Hepatic encephalopathy (HE) is an important complication of cirrhosis with significant morbidity and mortality. Management of HE primarily involves avoidance of precipitating factors and administration of various ammonia-lowering therapies such as non-absorbable disaccharides, antimicrobial agents like rifaximin and L-ornithine L-aspartate. The non-absorbable disaccharides which include lactulose and lactitol are considered the first-line therapy for the treatment of HE and in primary and secondary prophylaxis of HE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects. Rifaximin is effective in treatment of HE and recent systemic reviews found it comparable to disaccharides and is effective in secondary prophylaxis of HE. H epatic encephalopathy (HE) is a complex neuropsychiatric syndrome, which may complicate acute, chronic liver failure or patients with portal-systemic shunting. It is characterized by changes in mental state including a wide range of neuropsychiatric symptoms ranging from minor signs of altered brain function to deep coma. 1,2 It is one of the commonest indications for admission in intensive care unit in patients with advanced cirrhosis. There were over 40 000 patients hospitalized in the United States alone for a primary diagnosis of HE, resulting in total charges of approximately $932 million. Data in other countries are lacking, hence it causes a huge burden financially to the patient and society. 3 The West Haven Criteria are most often used to grade HE, with scores ranging from I-IV (IV being coma). However, it is a challenge to diagnose patients with minimal hepatic encephalopathy (MHE) or grade 1 HE; so it might be practical to combine these entities and name them covert HE for clinical use and overt HE to patients with grade II to IV. 1,4,5 One of the major tenets of the pathophysiology of HE is hyperammonemia that results from an increased nitrogenous load from the gastrointestinal tract and reduced urea synthesis both due to portal-systemic shunting and decreased urea hepatic synthesis. Brain and skeletal muscle neither remove nor produce ammonium in normal conditions, but they are able to seize ammonium during hyperammonemia, releasing glutamine. Ammonia is produced both by bacterial degradation of amines, aminoacids, purines, and urea as well as enterocytic glutaminase activity that converts glutamine to glutamate and ammonia. 6,7 Astrocytes play an important role in the pathogenesis of HE with consequences for neuronal function. Astrocytes have the ability to eliminate ammonia by the synthesis of glutamine through amidation of glutamate by the enzyme glutamine synthetase Hyperammonemia leads to the accumulation of glutamine within astrocytes, which exerts an osmotic stress that causes astrocytes to take in water and swell. 8,9 This article reviewed the clinical impact, pathogenesis, and management of overt HE in patients with cirrhosis. Articles published between January 1960 and November 2013 were acquired through a MEDLINE search of different combi...

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“…Lactulose and lactitol both have been used for the treatment of HE and lactulose has been compared with lactitol in various studies (32,33,(50)(51)(52)(53)(54)(55)(56)(57) (Table-2). Morgan et al(32) enrolled twenty-five cirrhotic patients experiencing 28 episodes of acute hepatic encephalopathy which were randomized blindly to treatment with either lactitol (n = 15) or lactulose (n = 13).…”

Section: Lactulose Versus Lactitol For the Treatment Of Hepatic Encepmentioning

confidence: 99%

Disaccharides in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis

Sharma¹

2012

Miscellanea on Encephalopathies - A Second Look

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Lactitol vs. lactulose in the treatment of chronic recurrent portal-systemic encephalopathy

Cited by 30 publications

References 12 publications

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

Management of Overt Hepatic Encephalopathy

Disaccharides in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis

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