Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review and meta‐analysis

Gluud, Lise Lotte; Vilstrup, Hendrik; Morgan, Marsha Y.

doi:10.1002/hep.28598

Cited by 95 publications

(65 citation statements)

References 44 publications

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“…The major difficulty with these approaches is that they do not provide point diagnostic information and thus are not of value to clinicians who need to decide whether to treat a patient for HE at a given point in time; given the low toxicity of treatments prescribed for HE [4], it is hardly operational to wait for longitudinal data to see if the patient truly has HE or whether they may develop HE at some point in the future. As an alternative we would advocate retention of normative thresholds.…”

Section: To the Editormentioning

confidence: 99%

Tools and tactics for improving the diagnosis of hepatic encephalopathy

Olesen

Jackson

Morgan

2017

Journal of Hepatology

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Section: To the Editormentioning

confidence: 99%

Tools and tactics for improving the diagnosis of hepatic encephalopathy

Olesen

Jackson

Morgan

2017

Journal of Hepatology

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“…A systematic metaanalysis has shown nonabsorbable disaccharides to be useful in the treatment and prevention of HE. 20 Lactulose is useful in the treatment of HE. Studies have established its role in primary as well as secondary prophylaxis of overt HE.…”

Section: Ejohgmentioning

confidence: 99%

Managing encephalopathy in the outpatient setting

Rathi

Dhiman

2016

Clinical Liver Disease

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In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination. Presence of poor work productivity, increased accidental injuries on complex machinery and driving, etc., raise the suspicion of cognitive dysfunction. Specialized neurocognitive testing like psychometric HE, computerized tests like critical flicker frequency tests, inhibitory control tests, Stroop encephalopathy tests, and electroencephalography are needed to diagnose overt HE. Various studies have shown lactulose and rifaximin to be useful in overt HE. However, presence of persistent and recurrent HE in cirrhosis is an indication for liver transplant. Lactulose is effective both in improving reversal of minimal HE and in reducing the risk of development of overt HE.

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“…Lactulose can significantly lower ammonia levels and has served as the primary therapy for HE. A systematic review involved 38 randomized controlled trials (RCTs) and evaluated the effects of the non‐absorbable disaccharides (NADs), showing that NADs had a beneficial effect on overt HE (OHE) episodes, secondary prophylaxis and primary prophylaxis for preventing the development of HE . Lactulose, in studies primarily from India, has shown a beneficial impact on MHE reversal and on quality of life (QoL) .…”

Section: Introductionmentioning

confidence: 99%

“…A systematic review involved 38 randomized controlled trials (RCTs) and evaluated the effects of the nonabsorbable disaccharides (NADs), showing that NADs had a beneficial effect on overt HE (OHE) episodes, secondary prophylaxis and primary prophylaxis for preventing the development of HE. 11 Lactulose, in studies primarily from India, has shown a beneficial impact on MHE reversal and on quality of life (QoL). 12 Further, Bajaj et al 8 and Sarangi et al 13 proved that NADs can beneficially affect microbiota composition.…”

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confidence: 99%

Lactulose improves cognition, quality of life, and gut microbiota in minimal hepatic encephalopathy: A multicenter, randomized controlled trial

Wang

Bajaj

Wang

et al. 2019

J of Digest Diseases

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Objective Lactulose is effective in the treatment and prevention of overt hepatic encephalopathy (OHE), but there are limited data on its use on microbiota in relations to minimal hepatic encephalopathy (MHE) recovery. The present study aimed to assess the efficacy of lactulose in recovery of MHE in aspects of cognitive function, quality of life, and impact on intestinal microbiota. Methods This multicenter, open‐label randomized controlled trial was conducted in 11 teaching hospitals in China. Participants were randomly allocated on a 2:1 basis to receive lactulose (Gp‐L) or no therapy as control (Gp‐NL) for 60 days. The primary endpoint was the MHE reversal rate. Gut microbiota were compared between MHE patients and healthy volunteers, as well as lactulose‐responders and non‐responders. Results A total of 98 cirrhotic patients were included in the study, with 31 patients in the Gp‐NL group and 67 patients in the Gp‐L group. At day 60, the MHE reversal rate in Gp‐L (64.18%) was significantly higher than that in Gp‐NL (22.58%) (P = .0002) with a relative risk of 0.46 (95% confidence interval 0.32‐0.67). Number needed to treat was 2.4. Further, there was significantly more improvement in physical functioning in Gp‐L (4.62 ± 6.16) than in Gp‐NL (1.50 ± 5.34) (P = .0212). Proteobacteria was significantly higher in MHE patients compared with healthy volunteers (12.27% vs 4.65%, P < .05). Significant differences were found between lactulose responders and non‐responders in Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria. Conclusions Treatment with lactulose significantly improves MHE recovery rate, and gut microbiota change in MHE patients can modulate the effectiveness of this therapy. Chinese Clinical Trial Register (ChiCTR) (ID: ChiCTR‐TRC‐12002342).

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Nonabsorbable disaccharides for hepatic encephalopathy: A systematic review and meta‐analysis

Abstract: NADs have beneficial effects in the treatment and prevention of HE; their use, in this context, confers additional benefits including a reduction in serious liver-related morbidities and all-cause mortality. (Hepatology 2016;64:908-922).

Cited by 95 publications

References 44 publications

Tools and tactics for improving the diagnosis of hepatic encephalopathy

Tools and tactics for improving the diagnosis of hepatic encephalopathy

Managing encephalopathy in the outpatient setting

Lactulose improves cognition, quality of life, and gut microbiota in minimal hepatic encephalopathy: A multicenter, randomized controlled trial

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