Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial

Rattanasupar, Attapon; Chang, Arunchai; Akarapatima, Keerati; Chaojin, Thanongsak; Piratvisuth, Teerha

doi:10.1007/s12664-021-01150-2

Cited by 9 publications

(20 citation statements)

References 21 publications

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“…To search for acute infective gastroenteritis, an anamnesis of diarrhea with or without fever and the presence of pathogens in the stool should be performed. Gastrointestinal bleeding is associated with an increase in blood ammonia, which is part of the reason that it is another major precipitant of HE [ 32 ]. The incidence of HE after GI bleeding is 10–39% in patients with Child–Pugh B or C cirrhosis [ 1 ].…”

Section: Management Of Overt He In Hospitalized Patientsmentioning

confidence: 99%

“…There are conflicting data on the primary prophylaxis of HE in patients with acute gastrointestinal bleeding. Different RCTs showed that the use of lactulose in cirrhotic patients hospitalized for acute gastrointestinal bleeding is effective in preventing HE compared with a placebo [ 33 , 34 ], while another RCT by Rattanasupar A. et al suggested the ineffectiveness of lactulose in preventing HE in these patients [ 35 ]. These data suggest the need for more studies to assess the efficacy of primary prophylaxis of HE in patients with decompensated cirrhosis and GI bleeding.…”

Section: Management Of Overt He In Hospitalized Patientsmentioning

confidence: 99%

“…Another recent RCT demonstrated that ammonia-lowering drugs (lactulose, rifaximin and L-ornithine L-aspartate) were found to be effective in preventing OHE in these patients [ 33 ]. In contrast, Rattanasupar A. et al conducted a randomized, double-blinded, placebo-controlled, multicenter study in which they compared a lactulose group and a placebo group, showing no differences in HE incidence in the two groups, suggesting that unnecessary treatment with laxatives should be avoided in these patients [ 35 ]. These conflicting data should stimulate new research on the efficacy of pharmacological primary prophylaxis in these patients.…”

Section: Therapeutic Managementmentioning

confidence: 99%

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The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

Bellafante,

Gioia,

Faccioli

et al. 2023

JCM

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Hepatic encephalopathy (HE) is a common complication of advanced liver disease and acute liver failure. It is a condition that features several neuropsychiatric symptoms that affect mortality, morbidity and the quality of patients’ and caregivers’ lives. An HE diagnosis is generally an exclusion diagnosis. Once the patient is admitted to the hospital, clinical examination, blood tests and eventually neuroimaging should be performed with the aim of ruling out other causes of acute brain dysfunction. Moreover, HE is recognized using various precipitants that can potentially promote its onset, alone or in combination, and must be identified. Once the diagnostic process is complete, a correct treatment should be started. The anti-HE treatment is based on a combination of the correction of precipitants; non-absorbable antibiotics, such as rifaximin; and non-absorbable disaccharides. Once the patient is discharged from the hospital, specific anti-HE therapy should be maintained in order to prevent other HE episodes.

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Section: Management Of Overt He In Hospitalized Patientsmentioning

confidence: 99%

Section: Management Of Overt He In Hospitalized Patientsmentioning

confidence: 99%

Section: Therapeutic Managementmentioning

confidence: 99%

See 1 more Smart Citation

The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

Bellafante,

Gioia,

Faccioli

et al. 2023

JCM

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“…Rattanasupar and colleagues, from Hatyai Hospital, Songkhla, Thailand, report a randomized, double-blinded, placebo-controlled, multicenter study in 46 cirrhotic patients presenting with acute UGIB randomized to receive lactulose or placebo for 5 days along with standard treatment [20]. Nine (19.6%) patients developed HE: 5 (22.7%) in the placebo group and 4 (16.7%) in the lactulose group (p = 0.718).…”

Section: Role Of Lactulose For Prophylaxis Against Hepatic Encephalop...mentioning

confidence: 99%

Editorial commentary on Indian Journal of Gastroenterology—November–December 2021

Limdi

2021

Indian J Gastroenterol

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Fetuin-A in newly detected type 2 diabetes mellitus as a marker of non-alcoholic fatty liver diseaseA growing body of evidence implicates hepatokines such as fetuin-A and fetuin-B in the prognoses of non-alcoholic fatty liver disease (NAFLD), its associated complications and in the development of obesity, hyperglycemia, hypertriglyceridemia, and chronic diseases, such as metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease [1]. The association between Fetuin-A in newly diagnosed T2DM (NDD) and its corelation with NAFLD is less well understood.Yamasandhi and colleagues from Ramaiah Memorial Hospital, Bangalore, India, report a case-control study measuring fetuin-A levels in 60 NDD's with and without NAFLD [2]. Fetuin-A was significantly higher in NDD with NAFLD compared to those without NAFLD and showed an increasing trend with the advancement of fibrosis. A cut-off value of 1239 mcg/mL was able to differentiate NAFLD patients with area under curve (AUC) of 0.667 (sensitivity 75%; specificity 61%) and remained significant after adjustment for potential confounders such as age, weight, blood pressure, lipids, and liver enzymes. These findings need validation, but open up new perspectives in early diagnosis, identification of novel biomarkers, and providing novel targets for pharmacological interventions.

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“…On the contrary, another randomized controlled clinical trial showed that lactulose therapy did not reduce the incidence of HE after AVB and that high a Child–Pugh class and diarrhea were predictive for the development of HE. So, the authors concluded that in these patients, unnecessary laxatives should be avoided given their prophylactic ineffectiveness [ 7 ].…”

mentioning

confidence: 99%

Primary Prophylaxis of Overt Hepatic Encephalopathy: Is It Time to Consider It?

Faccioli

Nardelli

Gioia

et al. 2023

JCM

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Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial

Cited by 9 publications

References 21 publications

The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

The Management of Hepatic Encephalopathy from Ward to Domiciliary Care: Current Evidence and Gray Areas

Editorial commentary on Indian Journal of Gastroenterology—November–December 2021

Primary Prophylaxis of Overt Hepatic Encephalopathy: Is It Time to Consider It?

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