Idiopathic pneumatosis intestinalis secondary to lactulose use in patients with cirrhosis

Abstract

Background and Aim Few case reports exist that link lactulose use with pneumatosis intestinalis in cirrhotics. This study investigates the relationship between lactulose use and idiopathic pneumatosis intestinalis in a cohort of cirrhotic patients. Methods This case series considers several notable cases of patients with idiopathic pneumatosis intestinalis and concurrent lactulose use. Idiopathic pneumatosis intestinalis was defined as pneumatosis intestinalis with no identifiable etiology. A cohort of 119 patients with cirrhosis and pneumatosis intestinalis were identified in a tertiary care setting, via chart review by a multidisciplinary team. Eleven of these patients were found to have idiopathic pneumatosis intestinalis. Nine of these patients were being treated with lactulose. Results Six out of 9 patients with idiopathic pneumatosis intestinalis that were being treated with lactulose saw resolution of pneumatosis intestinalis following discontinuation of treatment. Conclusions The etiology of idiopathic pneumatosis intestinalis is likely multifactorial, but lactulose might play a preventable role in its formation.

Pneumatosis intestinalis in COVID-19

“…It should be noted that the cough was already resolved when the PI finding was not yet present at the first CT examination. The treatment with lactulose has been rarely associated with the occurrence of reversible idiopathic PI in patients with liver cirrhosis, 14 and lactitol (a disaccharide analogue of lactulose) has been reported as probable cause of recurrent PI associated with benign pneumoperitoneum even in patients without cirrhosis history 15 : because of the duration of treatment (only 6 days) and the low dose administered (average daily dose 25 mL), it is unlikely that lactulose can be the cause of PI in our non-cirrhotic patient.…”

Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

“…Discussions regarding the causal relationship between COVID-19 and TCZ with PI are beyond the scope of this publication. However, it is important to acknowledge that some medications that patients received (methylprednisolone and lactulose) may be linked to PI development (1,13,(79)(80)(81). Furthermore, these four critically-ill patients received intensive care support, which inherently adds numerous variables, including known and unknown interactions between each other and the host, resulting in an uncertain number of potential confounders.…”