Lactulose improves psychometric testing in cirrhotic patients with subclinical encephalopathy

Abstract

SUMMARYBackground : Therapeutic trials suggest that lactulose is an effective treatment of acute and chronic encephalopathy in cirrhotic patients. Aim and Methods : As it is likely that portal-systemic shunting and hepatocellular dysfunction are associated with some degree of neurological dysfunction, 14 patients with cirrhosis and documented portal-systemic shunting, but without detectable encephalopathy, were randomized to treatment with either lactulose 20 g t.d.s., or lactose 20 g t.d.s. as placebo, for a 15-day period. Monitoring included manually administered and computer-based psychometric testing, the results

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

“…[15][16][17] Several treatment modalities that reduce ammonia level have been tried in order to treat this condition, for example, dietary protein manipulation, 18 branched-chain amino acids, 19 L-ornithine L-aspartate, 20 lactulose, 21,22,46 and probiotics. 23 Most of the studies of these treatment modalities have found improvement in psychometry, [19][20][21][22][23] ammonia level, 20,23,24 and cerebral edema. 46 We did not measure ammonia level in our patients; however, we believe that improvement in the MHE in our patients most likely was related to the same mechanism.…”

“…[15][16][17] Therapeutic interventions that aim to reduce ammonia are also useful in this setting. [18][19][20][21][22][23][24] Most studies have shown improvement in psychomotor functions coupled with a reduction in ammonia level. Improvement in cognitive functions may translate into improvement in HRQOL.…”

“…HRQOL questionnaires have been used to study the influence of chronic diseases on daily life. [24][25][26][27] The Sickness Impact Profile (SIP) questionnaire, which assesses wide aspects of quality of life, has been used previously to determine the influence of chronic liver disease on patients' daily functioning. 3,[26][27][28] This study was carried out to determine the influence of treatment on psychomotor performance and HRQOL of patients with MHE.…”

Management of Covert Hepatic Encephalopathy

“…Therefore, lactulose was deemed to be effective in the primary prevention of overt hepatic encephalopathy. 25 Congruent with prior results, several other studies have reported an improvement in neuropsychometric tests with various doses and durations of lactulose and lactitol treatment [25][26][27][28][29][30] (Table 1).…”

Disaccharides in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis

“…In most of these trials patients had cirrhosis with acute, chronic, acute or chronic or minimal hepatic encephalopathy (37)(38)(39)(40)(41)(42)(43)(44). Oral lactulose was used in majority of these studies though some had used lactitol and lactulose enemas also (40).…”