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hepatic encephalopathy lactulose

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https://www.readbyqxmd.com/read/28316761/polyethylene-glycol-and-lactulose-versus-lactulose-alone-in-the-treatment-of-hepatic-encephalopathy-in-patients-with-cirrhosis-a-non-inferiority-randomized-controlled-trial
#1
Mohammadreza Naderian, Heshmatollah Akbari, Morteza Saeedi, Amir Ali Sohrabpour
BACKGROUND In this clinical trial, polyethylene glycol (PEG) solution was compared with lactulose in the treatment of hepatic encephalopathy in patients with cirrhosis. METHODS This randomized controlled trial was performed on 40 patients in two groups. The patients in the lactulose group received either 20-30 grams of lactulose orally or by a nasogastric tube, or 200 grams of lactulose enema by a rectal tube. The patients in the PEG-lactulose group received the same amount of oral or rectal lactulose, plus 280 grams of PEG in 4 liters of water orally as a single dose in 30-120 minutes...
January 2017: Middle East Journal of Digestive Diseases
https://www.readbyqxmd.com/read/28230908/probiotics-for-people-with-hepatic-encephalopathy
#2
REVIEW
Rohan Dalal, Richard G McGee, Stephen M Riordan, Angela C Webster
BACKGROUND: Hepatic encephalopathy is a disorder of brain function as a result of liver failure or portosystemic shunt or both. Both hepatic encephalopathy (clinically overt) and minimal hepatic encephalopathy (not clinically overt) significantly impair patient's quality of life and daily functioning, and represent a significant burden on healthcare resources. Probiotics are live micro-organisms, which when administered in adequate amounts, may confer a health benefit on the host. OBJECTIVES: To determine the beneficial and harmful effects of probiotics in any dosage, compared with placebo or no intervention, or with any other treatment for people with any grade of acute or chronic hepatic encephalopathy...
February 23, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28070704/sleep-disturbances-in-patients-of-liver-cirrhosis-with-minimal-hepatic-encephalopathy-before-and-after-lactulose-therapy
#3
Jatinderpal Singh, Barjesh Chander Sharma, Vinod Puri, Sanjeev Sachdeva, Siddharth Srivastava
Sleep disturbances are common in patients of cirrhosis with minimal hepatic encephalopathy (MHE) and affect health related quality of life (HRQOL). No study has evaluated effect of lactulose on sleep disturbances and correlation with HRQOL in patients with MHE. We assessed sleep disturbances in cirrhosis with MHE and effect of lactulose on sleep disturbances and HRQOL. One hundred patients of cirrhosis [MHE; (n = 50, age 45.3 ± 11.2 years, 45 males) no-MHE (n = 50, age 46.3 ± 10.4 years, 44 males)] were included...
April 2017: Metabolic Brain Disease
https://www.readbyqxmd.com/read/28059938/the-effects-of-probiotics-and-symbiotics-on-risk-factors-for-hepatic-encephalopathy-a-systematic-review
#4
Daniela Viramontes Hörner, Amanda Avery, Ruth Stow
Alterations in the levels of intestinal microbiota, endotoxemia, and inflammation are novel areas of interest in the pathogenesis of hepatic encephalopathy (HE). Probiotics and symbiotics are a promising treatment option for HE due to possible beneficial effects in modulating gut microflora and might be better tolerated and more cost-effective than the traditional treatment with lactulose, rifaximin or L-ornithine-L-aspartate. A systematic search of the electronic databases PubMed, ISI Web of Science, EMBASE, and Cochrane Library was conducted for randomized controlled clinical trials in adult patients with cirrhosis, evaluating the effect of probiotics and symbiotics in changes on intestinal microflora, reduction of endotoxemia, inflammation, and ammonia, reversal of minimal hepatic encephalopathy (MHE), prevention of overt hepatic encephalopathy (OHE), and improvement of quality of life...
January 5, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28051800/%C3%A2-minimal-hepatic-encephalopathy-in-cirrhosis-how-long-to-treat
#5
RANDOMIZED CONTROLLED TRIAL
Omesh Goyal, Sandeep S Sidhu, Harsh Kishore
INTRODUCTION: Minimal hepatic encephalopathy (MHE) can reverse after short-term treatment. However, relapse rate of MHE after stopping treatment has not been studied so far. We aimed to evaluate long-term (9 months) efficacy of a short-term (3 months) treatment of MHE with lactulose/rifaximin, for maintenance of remission from MHE. MATERIAL AND METHODS: In this prospective study, consecutive patients with cirrhosis and MHE were treated with lactulose/rifaximin for 3 months...
January 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/27885712/a-randomized-controlled-trial-comparing-lactulose-plus-albumin-versus-lactulose-alone-for-treatment-of-hepatic-encephalopathy
#6
Barjesh Chander Sharma, Jatinderpal Singh, Siddharth Srivastava, Alok Sangam, Alok Kumar Mantri, Nirupma Trehanpati, Shiv Kumar Sarin
BACKGROUND: Hepatic encephalopathy (HE) is associated with poor prognosis and treatment of HE is primarily directed at the reduction of the blood ammonia levels. We evaluated the efficacy and safety of albumin plus lactulose versus lactulose alone for treatment of overt HE. METHODS: In prospective randomized controlled trial, 120 patients with overt HE were randomized in 2 groups; group A lactulose plus albumin (n = 60) and group B, lactulose alone (n = 60)...
November 25, 2016: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27878780/a-pilot-study-using-lactulose-in-management-of-minimal-hepatic-encephalopathy-in-children-with-extrahepatic-portal-vein-obstruction
#7
Hanaa Mostafa El-Karaksy, Omneya Afifi, Azza Bakry, Ann Abdel Kader, Noha Saber
BACKGROUND: Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE. METHODS: A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013...
February 2017: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/27721918/implication-of-the-intestinal-microbiome-in-complications-of-cirrhosis
#8
REVIEW
Mamatha Bhat, Bianca M Arendt, Venkat Bhat, Eberhard L Renner, Atul Humar, Johane P Allard
The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma...
September 28, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27672280/clinical-management-of-acute-liver-failure-results-of-an-international-multi-center-survey
#9
Liane Rabinowich, Julia Wendon, William Bernal, Oren Shibolet
AIM: To assess the practice of caring for acute liver failure (ALF) patients in varying geographic locations and medical centers. METHODS: Members of the European Acute Liver Failure Consortium completed an 88-item questionnaire detailing management of ALF. Responses from 22 transplantation centers in 11 countries were analyzed, treating between 300 and 500 ALF cases and performing over 100 liver transplants (LT) for ALF annually. The questions pertained to details of the institution and their clinical activity, standards of care, referral and admission, ward- based care versus intensive care unit (ICU) as well as questions regarding liver transplantation - including criteria, limitations, and perceived performance...
September 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27645714/comment-on-treatment-of-acute-hepatic-encephalopathy-comparing-the-effects-of-adding-rifaximin-to-lactulose-on-patient-outcomes
#10
EDITORIAL
Sarah E Petite
No abstract text is available yet for this article.
December 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27582881/the-role-of-antioxidants-and-zinc-in-minimal-hepatic-encephalopathy-a-randomized-trial
#11
Nasser Mousa, Ahmed Abdel-Razik, Ashraf Zaher, Magdy Hamed, Gamal Shiha, Narmin Effat, Sherif Elbaz, Rania Elhelaly, Mohamed Hafez, Niveen El-Wakeel, Waleed Eldars
BACKGROUND: Minimal hepatic encephalopathy (MHE) has a far-reaching impact on quality and function ability in daily life and may progress to overt hepatic encephalopathy. There is a synergistic effect between systemic oxidative stress and ammonia that is implicated in the pathogenesis of hepatic encephalopathy. The aim of this study is to investigate the effectiveness of oral supplementation of antioxidants and zinc gluconate on MHE versus lactulose. METHODS: Our study included 58 patients with cirrhosis diagnosed as having MHE by neuropsychometric tests, including number connection test part A (NCT-A), digit symbol test (DST) and block design tests (BDTs)...
September 2016: Therapeutic Advances in Gastroenterology
https://www.readbyqxmd.com/read/27571468/-hepatic-encephalopathy
#12
Davide Festi, Giovanni Marasco, Federico Ravaioli, Antonio Colecchia
Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4)...
July 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27509349/-acute-liver-failure-after-ingestion-of-ciprofloxacin
#13
Dominic Kaddu-Mulindwa, Frank Lammert, Alexander Maßmann, Andreas Link
HISTORY AND ADMISSION FINDINGS: A 23-year old female patient is referred to our intensive care unit from another hospital because of progredient neurological deterioration with sopor. One week before, she had experienced non-specific pain in her upper right stomach combined with vomitus and nausea. For two days, she had been treated with ciprofloxacin 2 × 500 mg / d by her primary care physician. Except for appendectomy in childhood, no other diseases were reported. Clinical investigation: Physical examination reveals mild scleral and dermal jaundice...
August 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27457247/epilepsy-as-a-risk-factor-for-hepatic-encephalopathy-in-patients-with-cirrhosis-a-cohort-study
#14
Peter Jepsen, Jakob Christensen, Karin Weissenborn, Hugh Watson, Hendrik Vilstrup
BACKGROUND: Epilepsy is associated with an increased mortality among cirrhosis patients, but the reasons are unknown. We aimed to determine whether epilepsy is a risk factor for developing hepatic encephalopathy (HE), which is a strong predictor of mortality. METHODS: We used data from three randomized 1-year trials of satavaptan in cirrhosis patients with ascites. With Cox regression, we compared the hazard rates of HE grade 1-4 between those cirrhosis patients who did or did not have epilepsy...
July 26, 2016: BMC Gastroenterology
https://www.readbyqxmd.com/read/27388776/lactulose-reduces-bacterial-dna-translocation-which-worsens-neurocognitive-shape-in-cirrhotic-patients-with-minimal-hepatic-encephalopathy
#15
Alba Moratalla, Javier Ampuero, Pablo Bellot, Rocío Gallego-Durán, Pedro Zapater, Manuela Roger, Blanca Figueruela, Belén Martínez-Moreno, José M González-Navajas, José Such, Manuel Romero-Gómez, Rubén Francés
BACKGROUND & AIMS: Minimal hepatic encephalopathy is associated with poor prognosis and mortality in patients with cirrhosis. We aimed at investigating whether bacterial-DNA translocation affects hyperammonaemia and neurocognitive scores in patients with mHE according to the use of lactulose. METHODS: Observational study including 72 mHE cirrhotic patients, as defined by a psychometric hepatic encephalopathy score (PHES)<-4 and/or a critical flicker frequency (CFF)<39 Hz...
July 7, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27366216/cost-effectiveness-analysis-of-rifaximin-%C3%AE-administration-for-the-reduction-of-episodes-of-overt-hepatic-encephalopathy-in-recurrence-compared-with-standard-treatment-in-france
#16
Anastasiia Kabeshova, Soumaia Ben Hariz, Elyonore Tsakeu, Robert Benamouzig, Robert Launois
BACKGROUND: Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome that occurs most often in a context of acute or chronic liver disease. Despite the seriousness of the pathology, only a few treatments have been developed for improving its management. Rifaximin-α is the first treatment that has been clinically developed for overt HE (OHE) episodes. Recent results of clinical studies demonstrated its significant improvement in the health-related quality of life. The objective of the current study was to estimate the long-term cost-effectiveness of rifaximin-α used in combination with lactulose compared with lactulose monotherapy in cirrhotic patients, who have experienced at least two prior OHE events...
July 2016: Therapeutic Advances in Gastroenterology
https://www.readbyqxmd.com/read/27310548/efficacy-of-lactulose-in-the-prophylaxis-of-hepatic-encephalopathy-in-cirrhotic-patients-presenting-gastrointestinal-bleeding
#17
REVIEW
Felipe Toyama Aires, Paola Teruya Ramos, Wanderley Marques Bernardo
INTRODUCTION: Hepatic encephalopathy (HE) is a bad prognostic factor in patients with liver cirrhosis and its incidence is associated with several triggering factors being the most prevalent gastrointestinal bleeding. Lactulose, despite its questionable efficacy in the literature, is considered a first line treatment in patients with HE. OBJECTIVE: To evaluate the effectiveness of lactulose in preventing HE in cirrhotic patients with gastrointestinal bleeding. METHOD: A systematic review of the literature using the Medline scientific database...
May 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27255094/predictor-of-90-day-readmission-rate-for-hepatic-encephalopathy
#18
Supannee Rassameehiran, Charoen Mankongpaisarnrung, Grerk Sutamtewagul, Saranapoom Klomjit, Ariwan Rakvit
OBJECTIVES: The purpose of our study was to identify clinical parameters associated with readmissions within 90 days in patients with hepatic encephalopathy (HE). METHODS: We reviewed electronic medical records of patients admitted between January 1, 2010 and September 30, 2013 at University Medical Center, Lubbock, Texas. Inclusion criteria were admission to the hospital with diagnosis of HE in patients older than 18 years. We compared the patients with readmission within 90 days with patients with no readmission using routine clinical data...
June 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/27182210/contemporary-understanding-and-management-of-overt-and-covert-hepatic-encephalopathy
#19
Meghan NeSmith, Joseph Ahn, Steven L Flamm
Hepatic encephalopathy (HE) is a major complication of liver disease that leads to significant morbidity and mortality. Caring for hospitalized patients with HE is becoming more complex, and the economic burden of HE continues to rise. Defining and diagnosing HE, particularly covert HE (CHE), remain challenging. In this article, we review new tools and those currently under development for the diagnosis of CHE and the latest advances in the acute and long-term management of overt HE (OHE) and CHE. In particular, we review the latest data on the use of lactulose and rifaximin for treatment of OHE and summarize the data on adjunctive agents such as sodium benzoate and probiotics...
February 2016: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27153247/non-absorbable-disaccharides-versus-placebo-no-intervention-and-lactulose-versus-lactitol-for-the-prevention-and-treatment-of-hepatic-encephalopathy-in-people-with-cirrhosis
#20
REVIEW
Lise Lotte Gluud, Hendrik Vilstrup, Marsha Y Morgan
BACKGROUND: Non-absorbable disaccharides (lactulose and lactitol) are recommended as first-line treatment for hepatic encephalopathy. The previous (second) version of this review included 10 randomised clinical trials (RCTs) evaluating non-absorbable disaccharides versus placebo/no intervention and eight RCTs evaluating lactulose versus lactitol for people with cirrhosis and hepatic encephalopathy. The review found no evidence to either support or refute the use of the non-absorbable disaccharides and no differences between lactulose versus lactitol...
2016: Cochrane Database of Systematic Reviews
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