Lactitol in prevention of recurrent episodes of hepatic encephalopathy in cirrhotic patients with portal-systemic shunt

Abstract

Recurrent episodes of hepatic encephalopathy (HE) frequently occur in surgically shunted cirrhotic patients. The prevention of these episodes is based mainly on the long-term use of lactulose. Recently, lactitol, a nonabsorbable disaccharide similar to lactulose, has been proposed as an alternative in the management of HE. It has the advantage of being better tolerated and producing a more predictable catharsis. The effects of the two agents were compared in a controlled randomized study lasting six months involving 31 cirrhotic patients with portal-systemic shunt, of whom 40% experienced HE. The PSE index (mental state, EEG, asterixis, Raitan test, and ammonia) was assessed in each patient on entry to the study and every three months during treatment. Episodes of HE, side effects, and the patients' comments on efficacy, tolerability, and palatability were recorded. The dose required to induce two bowel movements per day was 48 +/- 25 ml of lactulose syrup and 36 +/- 7 g of lactitol. During the study, the number of patients who had an episode of HE and the PSE index was similar in both groups. The patients judged lactitol better from the point of view of palatability. Meteorism and flatulence, experienced by patients treated with lactulose, was not reported by the lactitol group. We concluded that lactitol is as effective as lactulose in the long-term prevention of episodes of HE in cirrhotics with portal-systemic shunt and may be better tolerated.

Assessment of Clinical, Laboratory and Endoscopic Risk Factors for Hepatic Encephalopathy Development in Egyptian Cirrhotic Patients with Upper GIT Bleeding

“…The frequency of infection as precipitating factor appears to be declining and gastrointestinal bleeding appears to be increasing [14] . Lactulose is effective in the management of hepatic encephalopathy [15] and in the prevention of secondary episodes of encephalopathy [16] . Gut irrigation with paromomycine plus lactulose had been found to be effective in the prevention of encephalopathy devolvement after upper GIT bleed in previous trials [17] .…”

Management of Overt Hepatic Encephalopathy

“…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).…”

Disaccharides in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis

“…It is available in a highly soluble crystalline powder form and is reported to be less sweet in taste than lactulose. Clinical trials have reported lactitol dosages of 10-12 g every 6 hours, titrated to two bowel movements daily to be effective in treatment of HE (31,33). Disaccharides (both lactulose and lactitol) remain undigested until they reach the colon, where they get metabolized by the bacteria in the colon to acetic and lactic acid.…”

“…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).…”

“…Patients experienced fewer side effects during treatment with lactitol, but the pooled odds ratio was not statistically significant. In all studies lactitol was considered more palatable (50,55). Clinical effectiveness of lactitol, in long-term treatment of chronic encephalopathy, is similar to those of lactulose.…”