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A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy.

Abstract

BACKGROUND

Minimal hepatic encephalopathy (MHE) impairs daily functioning and health-related quality of life (HRQoL). The modalities of treatment of MHE have not been adequately studied.

AIMS

To compare lactulose, probiotics, and L-ornithine L-aspartate (LOLA) in treatment of MHE and effect on HRQoL by Sickness Impact Profile questionnaire.

METHODS

Consecutive patients with cirrhosis were screened for MHE. MHE was diagnosed by two or more abnormal psychometric tests (number/figure connection tests A and B, block design test, picture completion test). Patients were randomized to no treatment (GpA), lactulose 30-60 ml/twice per day (GpB), probiotics 110 billion colony forming units twice in a day (GpC), LOLA 6 g three times per day (GpD) for 3 months. Arterial ammonia and HRQoL assessment using SIP questionnaire was done at baseline and at 3 months.

RESULTS

One hundred and sixty (49.69%) of 322 patients with cirrhosis had MHE. After 3 months, MHE recovered in GpA four (10%), GpB 19 (47.5%), GpC 14 (35%), and GpD 14 (35%). MHE improved significantly in all three treatment groups (GpB, GpC, GpD) compared with no treatment (GpA) (P=0.006). Overt hepatic encephalopathy developed in nine (5.6%) of 160 patients; GpA four (10%), GpB one (2.5%), GpC two (5%), and GpD two (5%), respectively. There was significant improvement in SIP score in GpB (6.98±4.1), GpC (6.24±3.4), and GpD (7.33±3.8) versus GpA (1.05±2.6), P value of less than 0.001. The decrease in SIP score correlated with an improvement in MHE on multivariate analysis but there was no correlation with the type of intervention offered. There was no significant change in arterial ammonia level after therapy in GpA (-0.52±7.8 μmol/l). Arterial ammonia level in GpB (-8.47±5.8 μmol/l), GpC (-7.31±7.9 μmol/l), and GpD (-9.61±9.3 μmol/l) were significantly more than GpA (P<0.0001).

CONCLUSION

Lactulose, probiotics, and LOLA significantly improve MHE and HRQoL in patients with chronic liver disease.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology, G.B. Pant Hospital, University of Delhi, New Delhi, India.

    , ,

    Source

    MeSH

    Adult
    Ammonia
    Dipeptides
    Female
    Hepatic Encephalopathy
    Humans
    Lactulose
    Male
    Middle Aged
    Neuropsychological Tests
    Probiotics
    Psychometrics
    Quality of Life
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    21646910

    Citation

    Mittal, Vibhu Vibhas, et al. "A Randomized Controlled Trial Comparing Lactulose, Probiotics, and L-ornithine L-aspartate in Treatment of Minimal Hepatic Encephalopathy." European Journal of Gastroenterology & Hepatology, vol. 23, no. 8, 2011, pp. 725-32.
    Mittal VV, Sharma BC, Sharma P, et al. A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol. 2011;23(8):725-32.
    Mittal, V. V., Sharma, B. C., Sharma, P., & Sarin, S. K. (2011). A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. European Journal of Gastroenterology & Hepatology, 23(8), pp. 725-32. doi:10.1097/MEG.0b013e32834696f5.
    Mittal VV, et al. A Randomized Controlled Trial Comparing Lactulose, Probiotics, and L-ornithine L-aspartate in Treatment of Minimal Hepatic Encephalopathy. Eur J Gastroenterol Hepatol. 2011;23(8):725-32. PubMed PMID: 21646910.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. AU - Mittal,Vibhu Vibhas, AU - Sharma,Barjesh Chander, AU - Sharma,Praveen, AU - Sarin,Shiv Kumar, PY - 2011/6/8/entrez PY - 2011/6/8/pubmed PY - 2011/10/19/medline SP - 725 EP - 32 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 23 IS - 8 N2 - BACKGROUND: Minimal hepatic encephalopathy (MHE) impairs daily functioning and health-related quality of life (HRQoL). The modalities of treatment of MHE have not been adequately studied. AIMS: To compare lactulose, probiotics, and L-ornithine L-aspartate (LOLA) in treatment of MHE and effect on HRQoL by Sickness Impact Profile questionnaire. METHODS: Consecutive patients with cirrhosis were screened for MHE. MHE was diagnosed by two or more abnormal psychometric tests (number/figure connection tests A and B, block design test, picture completion test). Patients were randomized to no treatment (GpA), lactulose 30-60 ml/twice per day (GpB), probiotics 110 billion colony forming units twice in a day (GpC), LOLA 6 g three times per day (GpD) for 3 months. Arterial ammonia and HRQoL assessment using SIP questionnaire was done at baseline and at 3 months. RESULTS: One hundred and sixty (49.69%) of 322 patients with cirrhosis had MHE. After 3 months, MHE recovered in GpA four (10%), GpB 19 (47.5%), GpC 14 (35%), and GpD 14 (35%). MHE improved significantly in all three treatment groups (GpB, GpC, GpD) compared with no treatment (GpA) (P=0.006). Overt hepatic encephalopathy developed in nine (5.6%) of 160 patients; GpA four (10%), GpB one (2.5%), GpC two (5%), and GpD two (5%), respectively. There was significant improvement in SIP score in GpB (6.98±4.1), GpC (6.24±3.4), and GpD (7.33±3.8) versus GpA (1.05±2.6), P value of less than 0.001. The decrease in SIP score correlated with an improvement in MHE on multivariate analysis but there was no correlation with the type of intervention offered. There was no significant change in arterial ammonia level after therapy in GpA (-0.52±7.8 μmol/l). Arterial ammonia level in GpB (-8.47±5.8 μmol/l), GpC (-7.31±7.9 μmol/l), and GpD (-9.61±9.3 μmol/l) were significantly more than GpA (P<0.0001). CONCLUSION: Lactulose, probiotics, and LOLA significantly improve MHE and HRQoL in patients with chronic liver disease. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/21646910/A_randomized_controlled_trial_comparing_lactulose_probiotics_and_L_ornithine_L_aspartate_in_treatment_of_minimal_hepatic_encephalopathy_ L2 - http://Insights.ovid.com/pubmed?pmid=21646910 DB - PRIME DP - Unbound Medicine ER -