Predictors of nonresponse to lactulose for minimal hepatic encephalopathy in patients with cirrhosis

Abstract

The prevalence of MHE was 55% and MHE improved in 57% patients with lactulose. Baseline low serum sodium and high venous ammonia were highly predictive of nonresponse to lactulose therapy.

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

“…31 Four controlled trials with lactulose were excluded because either they did not report the outcome of interest (number of patients that improved or worsened with treatment 32 but only mean change in the psychometric tests) or involved patients with OHE 33 or were not placebo controlled (compared with fructo-oligosaccharides 34 ) or was not an RCT. 35 Similarly, search with fibre yielded a study with acarbose 36 in low grade hepatic encephalopathy that was excluded from our review as it did not report the outcomes of interest. The term latent hepatic encephalopathy yielded several studies none of which met our inclusion criteria i.e.…”

Comparison of the most favoured methods for the diagnosis of hepatic encephalopathy in liver transplantation candidates

“…The composite score of these five tests, the so-called psychometric hepatic encephalopathy score (PHES), has been shown to have a good predictive value for development of overt HE and for mortality in cirrhotic patients,10 to correlate with cerebral metabolic changes in patients with HE11 and to improve with HE treatment 12. Since norm data for the local population corrected for age and in some countries also for education are needed, a worldwide distribution of the test has not yet been achieved.…”

Pharmacotherapy of hepatic encephalopathy in cirrhosis

“…Finally, the predictors of non-response to lactulose were the degree of hyperammonemia (the higher ammonemia the poorer the response) and hyponatremia. These findings reaffirm the poor outcomes of the use of lactulose in patients with encephalopathy grade III --IV [41]. Despite the simple design of these studies with a 'hard' primary end-point and including a large number of patients, the lack of a comparator (blinded arm) implies that caution needs to be exercised in interpreting these data (Figure 4).…”