Observations on Antibiotics in the Treatment of Hepatic Coma and on Factors Contributing to Prognosis

Lactulose vs Polyethylene Glycol 3350-Electrolyte Solution for Treatment of Overt Hepatic Encephalopathy

“…Laxative agents such as magnesium salts were used prior to the introduction of lactulose, 7–9 suggesting that catharsis alone may be effective for treatment of HE. However, since the first report of the efficacy of lactulose in 1966, 5 and the consequent widespread adoption of nonabsorbable disaccharides for treatment of HE, there have been few studies comparing their effect with cathartic methods.…”

Ammonia absorption from the canine colon after portacaval shunt

“…In clinical practice, encephalopathic patients may be improved by administration of lactulose (Bircher et al, 1966) acid enemas (Jackson et al, 1974) and broad spectrum antibiotics, which inhibit urea-splitting organisms in the colon (Fast et al, 1958;Stormont et al, 1958) and also by resection of the colon or its exclusion (Walker et al, 1965;Resnick et al, 1968). All these procedures reduce the production and/or absorption of ammonia, and frequently, although not always, the concentration of ammonia in the blood falls following the successful administration of these treatments.…”

Hepatic encephalopathy

“…This has been proved since the 1930s, when it was observed that the administration of ammonia salt in patients with cirrhosis causes HE [82] and dogs with portosystemic shunt develop HE under the influence of ammoniagenic meat loads [83]. The beneficial action of disaccharides and oral antibiotics, both acting on gut bacteria, prove that the gut microbiota is implicated in the pathophysiology of HE [32,33,84,85].…”