[Effects of neomycin on intestinal digestion, absorption and fermentation of carbohydrates in patients with liver cirrhosis: evidence for an alternative therapeutic mechanism in hepatic encephalopathy].
BACKGROUND
Despite non absorbable antibiotics and neomycin may have antagonistic effects on intestinal bacterial environment, both have synergistic effects in the treatment of hepatic encephalopathy. This could be due to their action on different enteric flora or a neomycin induced carbohydrate malabsorption.


OBJECTIVE
To investigate the effects of neomycin on intestinal digestion, absorption and fermentation of carbohydrates in patients with liver cirrhosis.


METHODS
Thirty eight Child B or C cirrhotic patients separated in three groups; subjects within each group were randomized to receive neomycin (2/g/day for 10 days, n = 8) or placebo (n = 4). Absorption of lactose and d-xylose and fermentation of d-xylose, lactose and lactulose (measured using hydrogen breath tests) were studied before and after the treatment period.


RESULTS
Neomycin did not change lactose fermentation but reduced plasma glucose rise after lactose ingestion (38.8 +/- mg/dl to 22 +/- 6 mg/dl p < 0.05). Plasma d-xylose levels at 30 min and its 5 h urinary excretion were reduced by neomycin from 19 +/- 3 to 9 +/- 2 mg/dl and from 4.9 +/- 0, 8 to 2.6 +/- 0.3 g/5h respectively (p < 0.05). Fermentation of d-xylose, lactose and lactulose was not reduced by neomycin. No significant changes were observed after placebo treatment.


CONCLUSIONS
Neomycin therapy is associated with a reduction of intestinal digestion and absorption of carbohydrates, preserving bacterial fermentation capacity, probably increasing the non absorbable carbohydrate load reaching the colon.
Chesta
J
J
Centro de Gastroenterología, Hospital José Joaquín Aguirre, Universidad de Chile, Santiago.
Antezana
C
C
D050260:Carbohydrate Metabolism; D004063:Digestion / Q000187:drug effects; D005260:Female; D005285:Fermentation / Q000187:drug effects; D006501:Hepatic Encephalopathy / Q000188:drug therapy; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects*; D007785:Lactose / Q000378:metabolism; D007792:Lactulose / Q000378:metabolism; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000494:pharmacology* / Q000627:therapeutic use; D013997:Time Factors; D014994:Xylose / Q000378:metabolism
D007792:Lactulose; D014994:Xylose; D009355:Neomycin; D007785:Lactose
Efectos de neomicina sobre la digestion, absorción y fermentación intestinal de carbohidratos en pacientes con cirrosis hepatica: evidencia para un mecanismo terapeutico alternativo en la encefalopatia hepática.