Randomized Controlled Trial of Lactulose and Lactulose Plus Probiotics in the Treatment of Minimal Hepatic Encephalopathy

Abstract

BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with lactulose and probiotics has shown some benefit. We compared lactulose and a combination of lactulose plus probiotics in the treatment of MHE. PATIENTS AND METHODS: Fifty cirrhotic patients without overt encephalopathy were evaluated by psychometry (Number connection tests, Block design test and Digit symbol test). MHE was diagnosed by abnormal psychometry. Patients were randomized to receive lactulose [group 1 (n = 25): dose 30-60 ml/day], and probiotics plus lactulose [group 2 (n = 25) same dose of lactulose plus probiotic one capsule three times/ day, each capsule contained Streptococcus faecalis 60 million, Clostridium butyricum 4 million, Bacillus mesentricus 2 million, lactic acid bacillus 100 million]. Response was defined by normalization of the abnormal test parameters at six weeks treatment. RESULTS: MHE was diagnosed in 50 patients. Of the 50 patients, all had abnormal psychometry tests. Significant improvement was seen in abnormal psychometry tests in lactulose alone and lactulose plus probiotics groups after treatment. Normalization of abnormal psychometry was seen in 63%, and 60% of patients treated with lactulose alone and lactulose plus probiotics groups, respectively. CONCLUSION: All the patients with cirrhosis had MHE. Lactulose alone or combinations of both lactulose plus probiotic are equally effective in the treatment of MHE.

Enzymatic production of lactulose and epilactose in milk

“…An intake from 2 to 10 g of lactulose/d has been assigned to present prebiotic action (Terada et al, 1992;Mizota et al, 2002;Tuohy et al, 2002;Seki et al, 2007). This positive influence on the intestinal function has the potential to provide health benefits by alteration of colon microbiota as well as enhancing mineral adsorption as determined in several clinical trials (Oku and Okazaki, 1998;Seki et al, 2007;Sharma et al, 2008;Schuster-Wolff-Bühring et al, 2010). In Japan, the nutritional benefits of lactulose were acknowledged by the Japanese Ministry of Health and Welfare who claimed it as a "food of specific health use."…”

A 12-week Double-blind Randomized Clinical Trial Of Vitamin D3 Supplementation On Body Fat Mass In Healthy Overweight And Obese Women

“…However, it is difficult to control serum ammonia levels by diet therapies alone, and synthetic disaccharides, such as lactulose, and nonabsorbable antibiotics are utilized for treatment. Recently, lactulose and/or probiotic therapy have been shown to decrease serum ammonia levels [95]. Additionally, zinc supplementation is also effective in improving ammonia metabolism [96,97].…”

Diagnosis and treatment of hepatic encephalopathy

“…Results of meta-analysis and systemic review show that administration of probiotics or synbiotics is effective for hepatic encephalopathy treatment (39,40). MHE regresses, concentration of ammonia in the blood decreases, patients perform psychometric tests better, clinically expressed HE occurs less often as compared with patients who did not get this treatment (41)(42)(43)(44). According to the consensus of INASL on MHE, probiotics not only decrease endotoxemia, but also improve the functional indices of the liver, psychometric tests results, and quality of life (1b) (10).…”