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Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction.

Abstract

BACKGROUND/AIMS

Minimal hepatic encephalopathy (MHE) is common in patients with extrahepatic portal vein obstruction (EHPVO). There is no study on the treatment of MHE using lactulose in patients with EHPVO.

PATIENTS AND METHODS

Consecutive EHPVO patients were assessed by psychometric (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), and critical flicker frequency (CFF) at inclusion. Patients diagnosed as MHE were treated with lactulose and psychometric tests, CFF, and were reassessed after 3 months.

RESULTS

Of the 70 patients screened, the prevalence of abnormal psychometric test was as follows: NCT-A (41%), NCT-B (53%), DST (38%), SDT (40%), and LTT (44%). Thirty patients (43%) had two or more than two abnormal (>2 SD) psychometry tests. Lactulose improved MHE in 16/30 (53%) of patients after 3 months of treatment. Arterial ammonia decreased after lactulose treatment compared to baseline (83.7±19.1 vs. 65.1±19.3 μmol/l, P=0.001). A total of 9 (75%) of 12 patients with large spontaneous shunt and 7 (39%) of 18 patients without spontaneous shunt improved with lactulose (P=0.07). CFF in patients with MHE (n=30) was significantly lower than those without MHE (n=40) (38.1±2.4 vs. 41.5±3.1 Hz, P=0.01). CFF was less than 38 Hz in 21 (70%) of 30 patients before treatment and in 10 (33%) patients after lactulose therapy in MHE patients. All patients could tolerate lactulose without any significant side effects. Four patients (13%) developed transient diarrhea in whom dose needed reduction, 3 (10%) did not like its taste but have continued, and 2 (6%) developed abdominal bloating sensation.

CONCLUSIONS

Lactulose is effective in the treatment of MHE in patients with EHPVO.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India. drpraveen_sharma@yahoo.com

    Source

    MeSH

    Adult
    Biomarkers
    Chi-Square Distribution
    Disease Progression
    Female
    Flicker Fusion
    Gastrointestinal Agents
    Hepatic Encephalopathy
    Hepatic Veno-Occlusive Disease
    Humans
    Hypertension, Portal
    Lactulose
    Liver Function Tests
    Male
    Neuropsychological Tests
    Psychometrics
    Quality of Life
    Statistics, Nonparametric
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22626795

    Citation

    Sharma, Praveen, and Barjesh Chander Sharma. "Lactulose for Minimal Hepatic Encephalopathy in Patients With Extrahepatic Portal Vein Obstruction." Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, vol. 18, no. 3, 2012, pp. 168-72.
    Sharma P, Sharma BC. Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. Saudi J Gastroenterol. 2012;18(3):168-72.
    Sharma, P., & Sharma, B. C. (2012). Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, 18(3), pp. 168-72. doi:10.4103/1319-3767.96448.
    Sharma P, Sharma BC. Lactulose for Minimal Hepatic Encephalopathy in Patients With Extrahepatic Portal Vein Obstruction. Saudi J Gastroenterol. 2012;18(3):168-72. PubMed PMID: 22626795.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction. AU - Sharma,Praveen, AU - Sharma,Barjesh Chander, PY - 2012/5/26/entrez PY - 2012/5/26/pubmed PY - 2012/10/25/medline SP - 168 EP - 72 JF - Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association JO - Saudi J Gastroenterol VL - 18 IS - 3 N2 - BACKGROUND/AIMS: Minimal hepatic encephalopathy (MHE) is common in patients with extrahepatic portal vein obstruction (EHPVO). There is no study on the treatment of MHE using lactulose in patients with EHPVO. PATIENTS AND METHODS: Consecutive EHPVO patients were assessed by psychometric (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), and critical flicker frequency (CFF) at inclusion. Patients diagnosed as MHE were treated with lactulose and psychometric tests, CFF, and were reassessed after 3 months. RESULTS: Of the 70 patients screened, the prevalence of abnormal psychometric test was as follows: NCT-A (41%), NCT-B (53%), DST (38%), SDT (40%), and LTT (44%). Thirty patients (43%) had two or more than two abnormal (>2 SD) psychometry tests. Lactulose improved MHE in 16/30 (53%) of patients after 3 months of treatment. Arterial ammonia decreased after lactulose treatment compared to baseline (83.7±19.1 vs. 65.1±19.3 μmol/l, P=0.001). A total of 9 (75%) of 12 patients with large spontaneous shunt and 7 (39%) of 18 patients without spontaneous shunt improved with lactulose (P=0.07). CFF in patients with MHE (n=30) was significantly lower than those without MHE (n=40) (38.1±2.4 vs. 41.5±3.1 Hz, P=0.01). CFF was less than 38 Hz in 21 (70%) of 30 patients before treatment and in 10 (33%) patients after lactulose therapy in MHE patients. All patients could tolerate lactulose without any significant side effects. Four patients (13%) developed transient diarrhea in whom dose needed reduction, 3 (10%) did not like its taste but have continued, and 2 (6%) developed abdominal bloating sensation. CONCLUSIONS: Lactulose is effective in the treatment of MHE in patients with EHPVO. SN - 1998-4049 UR - https://www.unboundmedicine.com/medline/citation/22626795/Lactulose_for_minimal_hepatic_encephalopathy_in_patients_with_extrahepatic_portal_vein_obstruction_ L2 - http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2012;volume=18;issue=3;spage=168;epage=172;aulast=Sharma DB - PRIME DP - Unbound Medicine ER -