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Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose.
J Gastroenterol Hepatol 2012; 27(8):1329-35JG

Abstract

BACKGROUND AND AIM

Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE. There is no study on the prevention of overt HE using lactulose in patients who never had HE earlier.

METHODS

Consecutive cirrhotic patients who never had an episode of overt HE were randomized to receive lactulose (Gp-L) or no lactulose (Gp-NL). All patients were assessed by psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency test (CFF) at inclusion and after 3 months. These patients were followed every month for 12 months for development of overt HE.

RESULTS

Of 250 patients screened, 120 (48%) meeting the inclusion criteria were randomized to Gp-L (n = 60) and Gp-NL (n = 60). Twenty (19%) of 105 patients followed for 12 months developed an episode of overt HE. Six (11%) of 55 in the lactulose (Gp-L) group and 14 (28%) of 50 in the Gp-NL (P = 0.02) developed overt HE. Ten (20%) of 50 patients in Gp-NL and five (9%) of 55 patients in the Gp-L group died, P = 0.16. Number of patients with minimal hepatic encephalopathy (MHE) were comparable in two groups at baseline (Gp-L vs Gp-NL, 32:36, P = 0.29). Lactulose improved MHE in 66% of patients in Gp-L. Taking a cutoff < 38 Hz sensitivity and specificity of CFF in predicting HE were 52% and 77% at baseline and 52% and 82% at 3 months of treatment. On multivariate analysis, Child's score and presence of MHE at baseline were significantly associated with development of overt HE.

CONCLUSIONS

Lactulose is effective for primary prevention of overt hepatic encephalopathy in patients with cirrhosis.

Authors+Show Affiliations

Department of Gastroenterology, G B Pant Hospital, New Delhi, India.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22606978

Citation

Sharma, Praveen, et al. "Primary Prophylaxis of Overt Hepatic Encephalopathy in Patients With Cirrhosis: an Open Labeled Randomized Controlled Trial of Lactulose Versus No Lactulose." Journal of Gastroenterology and Hepatology, vol. 27, no. 8, 2012, pp. 1329-35.
Sharma P, Sharma BC, Agrawal A, et al. Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose. J Gastroenterol Hepatol. 2012;27(8):1329-35.
Sharma, P., Sharma, B. C., Agrawal, A., & Sarin, S. K. (2012). Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose. Journal of Gastroenterology and Hepatology, 27(8), pp. 1329-35. doi:10.1111/j.1440-1746.2012.07186.x.
Sharma P, et al. Primary Prophylaxis of Overt Hepatic Encephalopathy in Patients With Cirrhosis: an Open Labeled Randomized Controlled Trial of Lactulose Versus No Lactulose. J Gastroenterol Hepatol. 2012;27(8):1329-35. PubMed PMID: 22606978.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose. AU - Sharma,Praveen, AU - Sharma,Barjesh Chander, AU - Agrawal,Amit, AU - Sarin,Shiv Kumar, PY - 2012/5/22/entrez PY - 2012/5/23/pubmed PY - 2012/12/27/medline SP - 1329 EP - 35 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 27 IS - 8 N2 - BACKGROUND AND AIM: Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE. There is no study on the prevention of overt HE using lactulose in patients who never had HE earlier. METHODS: Consecutive cirrhotic patients who never had an episode of overt HE were randomized to receive lactulose (Gp-L) or no lactulose (Gp-NL). All patients were assessed by psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency test (CFF) at inclusion and after 3 months. These patients were followed every month for 12 months for development of overt HE. RESULTS: Of 250 patients screened, 120 (48%) meeting the inclusion criteria were randomized to Gp-L (n = 60) and Gp-NL (n = 60). Twenty (19%) of 105 patients followed for 12 months developed an episode of overt HE. Six (11%) of 55 in the lactulose (Gp-L) group and 14 (28%) of 50 in the Gp-NL (P = 0.02) developed overt HE. Ten (20%) of 50 patients in Gp-NL and five (9%) of 55 patients in the Gp-L group died, P = 0.16. Number of patients with minimal hepatic encephalopathy (MHE) were comparable in two groups at baseline (Gp-L vs Gp-NL, 32:36, P = 0.29). Lactulose improved MHE in 66% of patients in Gp-L. Taking a cutoff < 38 Hz sensitivity and specificity of CFF in predicting HE were 52% and 77% at baseline and 52% and 82% at 3 months of treatment. On multivariate analysis, Child's score and presence of MHE at baseline were significantly associated with development of overt HE. CONCLUSIONS: Lactulose is effective for primary prevention of overt hepatic encephalopathy in patients with cirrhosis. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/22606978/Primary_prophylaxis_of_overt_hepatic_encephalopathy_in_patients_with_cirrhosis:_an_open_labeled_randomized_controlled_trial_of_lactulose_versus_no_lactulose_ L2 - https://doi.org/10.1111/j.1440-1746.2012.07186.x DB - PRIME DP - Unbound Medicine ER -