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Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: a meta-analysis.
Eur J Gastroenterol Hepatol. 2011 Nov; 23(12):1250-7.EJ

Abstract

OBJECTIVE

To evaluate the clinical efficacy of lactulose in patients with minimal hepatic encephalopathy (MHE).

METHODS

Randomized controlled trials (RCTs) comparing lactulose with placebo or with no intervention in the management of MHE that were conducted from January 1990 to July 2011 were searched from MEDLINE, EMBASE, SCI, Cochrane Controlled Trials Register, and China Biological Medicine Database. Studies with a Jadad score higher than 3 were included in the meta-analysis and evaluated using RevMan5.0 software for relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (95% CI). Sensitivity analysis was performed on the ethnical differences and quality of the trials. Publication bias was observed using an inverted funnel plot.

RESULTS

Nine studies with 434 patients were included in the meta-analysis. Compared with placebo or no intervention, lactulose significantly reduced the risk of no improvement in neuropsychological tests (RR: 0.52, 95% CI: 0.44-0.62, P<0.00001), the time required for the completion of the number connection test-A (WMD: -26.95, 95% CI: -37.81 to -16.10, P<0.00001), and the mean number of abnormal neuropsychological tests (WMD: -1.76, 95% CI: -1.96 to -1.56, P<0.00001). Furthermore, the meta-analysis also showed that lactulose prevented the progression to overt hepatic encephalopathy (RR: 0.17, 95% CI: 0.06-0.52, P=0.002), reduced blood ammonia levels (WMD: -9.89 µmol/l, 95% CI: -11.01 to -8.77 µmol/l, P<0.00001), and improve health-related quality of life (WMD: -6.05, 95% CI: -6.30 to -5.20, P<0.00001). However, no significant difference was observed in the mortality of patients with MHE (RR: 0.75, 95% CI: 0.21-2.72, P=0.66), and lactulose significantly increased the incidence of diarrhea (RR: 4.38, 95% CI: 1.35-14.25, P=0.01).

CONCLUSION

Lactulose has significant beneficial effects for patients with MHE compared with placebo or no intervention.

Authors+Show Affiliations

Graduate School, Tianjin Medical University, Tianjin Infection Disease Hospital, Tianjin, China.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

21971378

Citation

Luo, Ming, et al. "Clinical Efficacy and Safety of Lactulose for Minimal Hepatic Encephalopathy: a Meta-analysis." European Journal of Gastroenterology & Hepatology, vol. 23, no. 12, 2011, pp. 1250-7.
Luo M, Li L, Lu CZ, et al. Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: a meta-analysis. Eur J Gastroenterol Hepatol. 2011;23(12):1250-7.
Luo, M., Li, L., Lu, C. Z., & Cao, W. K. (2011). Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: a meta-analysis. European Journal of Gastroenterology & Hepatology, 23(12), 1250-7. https://doi.org/10.1097/MEG.0b013e32834d1938
Luo M, et al. Clinical Efficacy and Safety of Lactulose for Minimal Hepatic Encephalopathy: a Meta-analysis. Eur J Gastroenterol Hepatol. 2011;23(12):1250-7. PubMed PMID: 21971378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: a meta-analysis. AU - Luo,Ming, AU - Li,Lei, AU - Lu,Chen-Zheng, AU - Cao,Wu-Kui, PY - 2011/10/6/entrez PY - 2011/10/6/pubmed PY - 2012/3/16/medline SP - 1250 EP - 7 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 23 IS - 12 N2 - OBJECTIVE: To evaluate the clinical efficacy of lactulose in patients with minimal hepatic encephalopathy (MHE). METHODS: Randomized controlled trials (RCTs) comparing lactulose with placebo or with no intervention in the management of MHE that were conducted from January 1990 to July 2011 were searched from MEDLINE, EMBASE, SCI, Cochrane Controlled Trials Register, and China Biological Medicine Database. Studies with a Jadad score higher than 3 were included in the meta-analysis and evaluated using RevMan5.0 software for relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (95% CI). Sensitivity analysis was performed on the ethnical differences and quality of the trials. Publication bias was observed using an inverted funnel plot. RESULTS: Nine studies with 434 patients were included in the meta-analysis. Compared with placebo or no intervention, lactulose significantly reduced the risk of no improvement in neuropsychological tests (RR: 0.52, 95% CI: 0.44-0.62, P<0.00001), the time required for the completion of the number connection test-A (WMD: -26.95, 95% CI: -37.81 to -16.10, P<0.00001), and the mean number of abnormal neuropsychological tests (WMD: -1.76, 95% CI: -1.96 to -1.56, P<0.00001). Furthermore, the meta-analysis also showed that lactulose prevented the progression to overt hepatic encephalopathy (RR: 0.17, 95% CI: 0.06-0.52, P=0.002), reduced blood ammonia levels (WMD: -9.89 µmol/l, 95% CI: -11.01 to -8.77 µmol/l, P<0.00001), and improve health-related quality of life (WMD: -6.05, 95% CI: -6.30 to -5.20, P<0.00001). However, no significant difference was observed in the mortality of patients with MHE (RR: 0.75, 95% CI: 0.21-2.72, P=0.66), and lactulose significantly increased the incidence of diarrhea (RR: 4.38, 95% CI: 1.35-14.25, P=0.01). CONCLUSION: Lactulose has significant beneficial effects for patients with MHE compared with placebo or no intervention. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/21971378/Clinical_efficacy_and_safety_of_lactulose_for_minimal_hepatic_encephalopathy:_a_meta_analysis_ L2 - http://dx.doi.org/10.1097/MEG.0b013e32834d1938 DB - PRIME DP - Unbound Medicine ER -