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hepatic encephalopathy lactulose

Steven L Flamm
Hepatic encephalopathy (HE) is a neuropsychiatric complication commonly associated with liver disease, namely cirrhosis. The inability of the liver to metabolize ammonia results in a buildup of ammonia, which can cross the blood-brain barrier and cause significant neurocognitive impairment. Up to 80% of patients with cirrhosis will experience HE and a large proportion of these patients are at high risk of recurrent HE. There are several factors to consider when developing a cost-effective approach to managing HE, such as patient compliance, the adverse event (AE) profile of drug therapy, efficacy of drug therapy, and relative cost-benefits of drug therapy...
March 2018: American Journal of Managed Care
Andrea Mancini, Francesca Campagna, Piero Amodio, Kieran M Tuohy
Hepatic encephalopathy (HE) is a debilitating neuropsychiatric condition often associated with acute liver failure or cirrhosis. Advanced liver diseases are characterized by a leaky gut and systemic inflammation. There is strong evidence that the pathogenesis of HE is linked to a dysbiotic gut microbiota and to harmful microbial by-products, such as ammonia, indoles, oxindoles and endotoxins. Increased concentrations of these toxic metabolites together with the inability of the diseased liver to clear such products is thought to play an important patho-ethiological role...
February 27, 2018: Food & Function
Qing Cao, Cheng-Bo Yu, Shi-Gui Yang, Hong-Cui Cao, Ping Chen, Min Deng, Lan-Juan Li
BACKGROUND: Minimal hepatic encephalopathy (MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE. DATA SOURCES: Seven electronic databases were searched for relevant randomized controlled trials (RCTs) published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated...
February 2018: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Brian C Davis, Jasmohan S Bajaj
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy. Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as hepatic encephalopathy. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of hepatic encephalopathy associated with alcohol use...
February 8, 2018: Alcoholism, Clinical and Experimental Research
Nauman Ismat Butt, Usman Ismat Butt, Aniqa Anser Tufail Khan Kakar, Tashia Malik, Arif Mahmood Siddiqui
OBJECTIVE: To compare the efficacy of lactulose plus rifaximin with efficacy of lactulose alone in the treatment of hepatic encephalopathy. STUDY DESIGN: A randomized controlled trial. PLACE AND DURATION OF STUDY: Department of Medicine, Jinnah Hospital, Lahore, from December 2014 to June 2015. METHODOLOGY: All patients who presented with hepatic encephalopathy due to decompensated chronic liver disease were randomly divided into two groups of 65 patients each...
February 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Andrew Holloway, Louise Groot, Klaartje van der Schaaf
Case summary: A 9-month-old female neutered domestic shorthair cat presented with a history of episodic ptyalism, lethargy and abnormal behaviour. The clinical signs together with elevated pre- and post-prandial bile acid concentrations were consistent with hepatic encephalopathy (HE). In the absence of a portosystemic shunt (PSS) on abdominal ultrasound, medical management of HE was established with a protein-restricted diet and lactulose and the neurological signs resolved. Following an episode of acute vomiting and haemorrhagic diarrhoea at 19 months of age abdominal ultrasonography was repeated...
January 2018: JFMS Open Reports
Daniel H Montes-Cortés, José L Novelo-Del Valle, Ivonne M Olivares-Corichi, José V Rosas-Barrientos, Luis J Jara, María Pilar Cruz-Domínguez
Hyperammonemia results from hepatic inability to remove nitrogenous products generated by protein metabolism of intestinal microbiota, which leads to hepatic encephalopathy (HE) in chronic liver disease (CLD). In ammonium neurotoxicity, oxidative stress (OxS) plays a pathogenic role. Our objective was to evaluate if intestinal mannitol is as effective and safe as conventional treatment for diminishing hyperammonemia, OxS, and HE in patients with CLD. MATERIAL AND METHODS: We included 30 patients with HE classified by "Haven Criteria for Hepatic Encephalopathy"...
January 10, 2018: American Journal of Emergency Medicine
Eelco F M Wijdicks
Hepatic encephalopathy is a common encephalopathy and one of the very few that are treatable. Lactulose has remained a standard pharmaceutical intervention and is listed as one of the World Health Organization's Essential Medicines. The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. This historical vignette reviews the gradual understanding of the complex liver-brain connection, the effective treatment of hepatic stupor with lactulose, and the immediate relevance of lactulose to the practice of consultative neurocritical care...
January 2, 2018: Neurocritical Care
Tarana Gupta, Sahaj Rathi, Radha K Dhiman
In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination...
January 2017: Euroasian journal of hepato-gastroenterology
Aditya Narayan Sarangi, Amit Goel, Ankur Singh, Avani Sasi, Rakesh Aggarwal
BACKGROUND: Gut microbiota may be altered in patients with cirrhosis, and may further change after administration of lactulose. We studied the composition of gut microbiota in patients with cirrhosis and assessed the effect on it of lactulose administration. METHODS: Stool specimens were collected from 35 patients with cirrhosis (male 26; median [range] age: 42 [29-65] years) and 18 healthy controls (male 14; 44.5 [24-67] years); 21 patients provided another specimen after lactulose administration for 55 [42-77] days...
November 28, 2017: BMC Gastroenterology
Yu P Sivolap
Hepatic encephalopathy is a common neuropsychiatric complication of serious liver diseases and serves as a marker for worsening of their course and increasing the risk of death. The principal pathogenesis factors of hepatic encephalopathy is the excessive formation of ammonia and its accumulation by astrocytes. A key role in the prevention and treatment of hepatic encephalopathy is played by drugs that prevent hyperammonemia and promote the removal of ammonia from the body, namely lactulose, rifaximin and L-ornithine-L-aspartate...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Luis Dabul, Andrew Droney, Juan Oms, Marcos A Sanchez-Gonzalez
Despite the anti-inflammatory benefits of steroids in the management of multiple medical conditions, they are associated with undesired metabolic and psychiatric side effects. We present a case of a 57-year-old Hispanic man with hepatic cirrhosis due to hepatitis C and no past medical history of psychiatric illnesses who became delirious after treatment with high doses of intravenous Dexamethasone. The patient presented to Larkin Community Hospital, USA with complaints of lower back pain requiring treatment with steroids for severe lumbar central canal stenosis...
September 10, 2017: Curēus
M M Lauridsen, S Mikkelsen, T Svensson, J Holm, C Klüver, J Gram, H Vilstrup, O B Schaffalitzky de Muckadell
BACKGROUND: Minimal hepatic encephalopathy (MHE) is clinically undetectable and the diagnosis requires psychometric tests. However, a lack of clarity exists as to whether the tests are in fact able to detect changes in cognition. AIM: To examine if the continuous reaction time test (CRT) can detect changes in cognition with anti-HE intervention in patients with cirrhosis and without clinically manifest hepatic encephalopathy (HE). METHODS: Firstly, we conducted a reproducibility analysis and secondly measured change in CRT induced by anti-HE treatment in a randomized controlled pilot study: We stratified 44 patients with liver cirrhosis and without clinically manifest HE according to a normal (n = 22) or abnormal (n = 22) CRT...
2017: PloS One
Ana de Lorenzo-Pinto, Raquel García-Sánchez, Almudena Lorenzo-Salinas
The administration of lactulose enemas instead of or in combination with oral lactulose is common practice in patients with hepatic encephalopathy. Lactulose is a non-absorbable disaccharide that is catabolized by the bacterial flora to short chain fatty acids (e.g., lactic acid and acetic acid) which lower the colonic pH. This pH favors the formation of non-absorbable NH4+ from NH3, trapping NH4+ in the colon and thus reducing plasma ammonia concentrations. Lactulose therapy is considered as a first-line treatment and can be administered both orally and rectally...
October 2017: Revista Española de Enfermedades Digestivas
Cheng-Jui Lin, Chi-Feng Pan, Sy-Yeuan Ju, Hsuan-Kai Tzeng, Shen-Wei Chen, Jhu-Ting Syu, Chih-Jen Wu
Lactulose is often used to treat hepatic encephalopathy or constipation, and also exhibits benefits to chronic renal insufficiency due to reduce nitrogen-related products in serum. The present study investigated the pharmacokinetics of lactulose, its removal rate through dialysis, and safety by administering lactulose 6.5 g (Lagnos Jelly Divided Pack 16.05 g) orally to six hemodialysis patients who resided in Taiwan. As a result, the means of maximum plasma concentrations (Cmax) and Time to reach Cmax (Tmax) were 3090 ± 970 ng/mL and 6...
October 2016: Journal of Food and Drug Analysis
Natália Ferreira Mendes, Flora França Nogueira Mariotti, José Simões de Andrade, Milena de Barros Viana, Isabel Cristina Céspedes, Márcia Regina Nagaoka, Luciana Le Sueur-Maluf
Lactulose is a nonabsorbable disaccharide commonly used in clinical practice to treat hepatic encephalopathy. However, its effects on neuropsychiatric disorders and motor behavior have not been fully elucidated. Male Wistar rats were bile-duct ligated, and 3 weeks after surgery, treated with lactulose administrated by gavage (1.43 or 3.57 g/kg), once a day for seven days. Plasma levels of ammonia, aspartate aminotransferase, total bilirubin, and creatinine were quantified and histopathological analysis of the livers was performed...
December 2017: Metabolic Brain Disease
S H Kang, Y B Lee, J-H Lee, J Y Nam, Y Chang, H Cho, J-J Yoo, Y Y Cho, E J Cho, S J Yu, M Y Kim, Y J Kim, S K Baik, J-H Yoon
BACKGROUND: Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth. AIM: To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications. METHODS: We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort)...
November 2017: Alimentary Pharmacology & Therapeutics
Kiran Ahire, Archana Sonawale
INTRODUCTION: Hepatic encephalopathy is challenging complication of liver dysfunction. Therapeutic treatment options for hepatic encephalopathy are currently limited and have appreciable risks and benefits associated with their use. Rifaximin is a novel anti microbiological agent with wide spectrum of activity that has shown promise as an alternative option for hepatic encephalopathy. AIMS AND OBJECTIVE: The present study was undertaken to compare the effectiveness of Rifaximin and Lactulose as a combination vs Lactulose alone, to compare the adverse effects and to study the rapidity of therapeutic effects of Rifaximin and Lactulose...
August 2017: Journal of the Association of Physicians of India
Sandeep Singh Sidhu, Barjesh Chander Sharma, Omesh Goyal, Harsh Kishore, Navpreet Kaur
High-quality data on the efficacy of L-ornithine L-aspartate (LOLA) in patients with cirrhosis and bouts of overt hepatic encephalopathy (OHE) are missing. We evaluated the efficacy of intravenous LOLA in the reversal of bouts of OHE in patients with cirrhosis. In this prospective, double-blind, randomized, placebo-controlled trial conducted at two tertiary care institutes in India, 370 patients with cirrhosis and bouts of OHE were screened. After exclusion, 193 (52.16%) patients were randomized to receive either intravenous infusions of LOLA (n = 98), 30 g daily, or placebo (n = 95) for 5 days...
July 27, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Eleni Theocharidou, Ameet Dhar, David Patch
Gastrointestinal motility is impaired in a substantial proportion of patients with cirrhosis. Cirrhosis-related autonomic neuropathy, increased nitric oxide production, and gut hormonal changes have been implicated. Oesophageal dysmotility has been associated with increased frequency of abnormal gastro-oesophageal reflux. Impaired gastric emptying and accommodation may result in early satiety and may have an impact on the nutritional status of these patients. Small intestinal dysmotility might be implicated in small intestinal bacterial overgrowth and increased bacterial translocation...
2017: Gastroenterology Research and Practice
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