Lactulose for Minimal Hepatic Encephalopathy in Patients with Extrahepatic Portal Vein Obstruction

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.

• Publication year

  2012

• Venue

  Saudi Journal of Gastroenterology

• Publication date

  2012-05-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.4103/1319-3767.96448PMID 22626795PMCID 3371418
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• Improvement with lactulose was more frequent in patients with large spontaneous shunts than in those without spontaneous shunts.

  Confidence 0.87

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• Critical flicker frequency was lower in patients with minimal hepatic encephalopathy than in those without it, and fewer patients had values below 38 Hz after lactulose therapy.

  Confidence 0.95

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• Arterial ammonia levels decreased after lactulose treatment compared with baseline.

  Confidence 0.98

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• Lactulose improved minimal hepatic encephalopathy in 16 of 30 patients after 3 months of treatment.

  Confidence 0.99

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review

• arterial ammonia

  biomarker, measurement

  The measured blood ammonia concentration used as a biochemical marker in the patients.

  Aliases: blood ammonia

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• critical flicker frequency

  assessment method, test

  A visual neurophysiologic test used to assess cognitive dysfunction in the patients.

  Aliases: CFF

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• extrahepatic portal vein obstruction

  condition

  A portal venous obstruction located outside the liver in the patient group studied.

  Aliases: EHPVO

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• lactulose

  treatment

  A non-absorbable disaccharide administered orally as the treatment under evaluation.

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• large spontaneous shunt

  anatomical feature

  A sizeable spontaneous portosystemic shunt identified in a subset of the patients.

  Aliases: spontaneous shunt

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• minimal hepatic encephalopathy

  condition

  A mild form of hepatic encephalopathy assessed with psychometric testing and critical flicker frequency in these patients.

  Aliases: MHE

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review
• psychometric tests

  assessment method, test

  A battery of cognitive tests used to detect minimal hepatic encephalopathy, including NCT-A, NCT-B, DST, SDT, and LTT.

  Aliases: psychometry tests

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewAK (4715169a40) reviewJake Seo (Twitter) (bmuzj8twwb) review

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