Clinical

Lactulose helps prevent recurrent hepatic encephalopathy

Last Updated: 2009-10-27 13:10:04 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Lactulose can help prevent recurrent encephalopathy in patients with cirrhosis, a randomized trial has shown - and what sets this study apart from others is that lactulose was used to prevent, rather than to treat, encephalopathy, the lead researcher said.

Dr. Praveen Sharma, from the Institute of Liver and Biliary Sciences, New Delhi, India, told Reuters Health, "Most medical people give lactulose to treat hepatic encephalopathy, but not for prophylaxis."

The findings, presented this week at the American College of Gastroenterology meeting in San Diego, California, stem from a study of 140 cirrhotic patients who had recovered from an episode of hepatic encephalopathy and were randomized to receive daily lactulose or placebo.

A variety of psychometric tests, such as the number connection test and the object assembly test, were performed at baseline, and most patients had at least one abnormal result.

During a median follow-up period of 14 months, 19.6% of lactulose-treated patients developed overt encephalopathy, much lower than the 46.8% rate seen in the placebo group (p = 0.001).

Lactulose use did not significantly affect mortality or hospital readmission rates for non-encephalopathy causes.

In addition, the authors found, having two or more abnormal psychometric tests was predictive of encephalopathy recurrence.

The take-home message, Dr. Sharma said, is to "give lactulose to cirrhotic patients who have had an episode of hepatic encephalopathy...to prevent a second episode."

Dr. Sharma said his team is now planning studies to investigate the use of lactulose for the "primary prophylaxis of hepatic encephalopathy and (to examine the) role of lactulose in acute variceal bleed."