Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis

Abstract

Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis.

Lactulose for Preventing Overt Hepatic Encephalopathy: Between Evidence and Unresolved Questions

“…Importantly, this benefit was not accompanied by an increased risk of serious adverse events or treatment discontinuation. These results reinforce the central role of lactulose in HE management and may inform future updates of international guidance, particularly regarding primary prophylaxis in selected high-risk patients [2,3].…”

Lactulose for Preventing Overt Hepatic Encephalopathy: Between Evidence and Unresolved Questions

“…Importantly, this benefit was not accompanied by an increased risk of serious adverse events or treatment discontinuation. These results reinforce the central role of lactulose in HE management and may inform future updates of international guidance, particularly regarding primary prophylaxis in selected high-risk patients [2,3].…”

Systematic Review of the Economic Burden of Overt Hepatic Encephalopathy and Pharmacoeconomic Impact of Rifaximin

“…A meta-analysis of 22 randomized controlled studies demonstrated that nonabsorbable disaccharides (i.e. lactulose, lactitol) were significantly more effective than placebo or no intervention for the prevention and treatment of HE (relative risk (RR) 0.58; 95% CI 0.48–0.69) [ 33 ]. A meta-analysis of 24 randomized controlled studies demonstrated that nonabsorbable disaccharides significantly reduced the risk of mortality compared with placebo or no intervention (RR 0.59; 95% CI 0.40–0.87) [ 33 ].…”

“…lactulose, lactitol) were significantly more effective than placebo or no intervention for the prevention and treatment of HE (relative risk (RR) 0.58; 95% CI 0.48–0.69) [ 33 ]. A meta-analysis of 24 randomized controlled studies demonstrated that nonabsorbable disaccharides significantly reduced the risk of mortality compared with placebo or no intervention (RR 0.59; 95% CI 0.40–0.87) [ 33 ]. For hospitalized patients with end-stage liver disease, lactulose use was associated with decreased risk of Clostridium difficile infection (OR 0.48; 95% CI 0.31–0.74; p < 0.001) [ 34 ], which is important given that C. difficile infection is associated with poor outcomes in hospitalized patients with cirrhosis (i.e.…”

Diagnosis and Management of Cirrhosis and Its Complications

“…Lactulose: relative to placebo, bloating (46% vs 15%), diarrhea (29% vs 37% but higher if excess intake), nausea (15% vs 2%)…”

Lactulose for Preventing Overt Hepatic Encephalopathy: Between Evidence and Unresolved Questions

“…Importantly, this benefit was not accompanied by an increased risk of serious adverse events or treatment discontinuation. These results reinforce the central role of lactulose in HE management and may inform future updates of international guidance, particularly regarding primary prophylaxis in selected high-risk patients [2,3].…”

Systematic Review of the Economic Burden of Overt Hepatic Encephalopathy and Pharmacoeconomic Impact of Rifaximin

“…A meta-analysis of 22 randomized controlled studies demonstrated that nonabsorbable disaccharides (i.e. lactulose, lactitol) were significantly more effective than placebo or no intervention for the prevention and treatment of HE (relative risk (RR) 0.58; 95% CI 0.48–0.69) [ 33 ]. A meta-analysis of 24 randomized controlled studies demonstrated that nonabsorbable disaccharides significantly reduced the risk of mortality compared with placebo or no intervention (RR 0.59; 95% CI 0.40–0.87) [ 33 ].…”

“…lactulose, lactitol) were significantly more effective than placebo or no intervention for the prevention and treatment of HE (relative risk (RR) 0.58; 95% CI 0.48–0.69) [ 33 ]. A meta-analysis of 24 randomized controlled studies demonstrated that nonabsorbable disaccharides significantly reduced the risk of mortality compared with placebo or no intervention (RR 0.59; 95% CI 0.40–0.87) [ 33 ]. For hospitalized patients with end-stage liver disease, lactulose use was associated with decreased risk of Clostridium difficile infection (OR 0.48; 95% CI 0.31–0.74; p < 0.001) [ 34 ], which is important given that C. difficile infection is associated with poor outcomes in hospitalized patients with cirrhosis (i.e.…”

Diagnosis and Management of Cirrhosis and Its Complications

“…Lactulose: relative to placebo, bloating (46% vs 15%), diarrhea (29% vs 37% but higher if excess intake), nausea (15% vs 2%)…”

Lactulose for Preventing Overt Hepatic Encephalopathy: Between Evidence and Unresolved Questions

“…Importantly, this benefit was not accompanied by an increased risk of serious adverse events or treatment discontinuation. These results reinforce the central role of lactulose in HE management and may inform future updates of international guidance, particularly regarding primary prophylaxis in selected high-risk patients [2,3].…”

Systematic Review of the Economic Burden of Overt Hepatic Encephalopathy and Pharmacoeconomic Impact of Rifaximin

“…A meta-analysis of 22 randomized controlled studies demonstrated that nonabsorbable disaccharides (i.e. lactulose, lactitol) were significantly more effective than placebo or no intervention for the prevention and treatment of HE (relative risk (RR) 0.58; 95% CI 0.48–0.69) [ 33 ]. A meta-analysis of 24 randomized controlled studies demonstrated that nonabsorbable disaccharides significantly reduced the risk of mortality compared with placebo or no intervention (RR 0.59; 95% CI 0.40–0.87) [ 33 ].…”

“…lactulose, lactitol) were significantly more effective than placebo or no intervention for the prevention and treatment of HE (relative risk (RR) 0.58; 95% CI 0.48–0.69) [ 33 ]. A meta-analysis of 24 randomized controlled studies demonstrated that nonabsorbable disaccharides significantly reduced the risk of mortality compared with placebo or no intervention (RR 0.59; 95% CI 0.40–0.87) [ 33 ]. For hospitalized patients with end-stage liver disease, lactulose use was associated with decreased risk of Clostridium difficile infection (OR 0.48; 95% CI 0.31–0.74; p < 0.001) [ 34 ], which is important given that C. difficile infection is associated with poor outcomes in hospitalized patients with cirrhosis (i.e.…”

Diagnosis and Management of Cirrhosis and Its Complications

“…Lactulose: relative to placebo, bloating (46% vs 15%), diarrhea (29% vs 37% but higher if excess intake), nausea (15% vs 2%)…”