title: Efficacy of lactulose in cirrhotic patients with subclinical hepatic encephalopathy.
abstract: To investigate the role of lactulose in the treatment of cirrhotic patients with subclinical hepatic encephalopathy (SHE), 40 cirrhotic patients, 33 males and 7 females, were included in the study. The diagnosis of SHE was made by quantitative psychometric tests including the number connection test (NCT), figure connection test (FCT) parts A and B, and two performance subtests of Wechsler adult intelligence scale, ie, picture completion (PC) and block design (BD) tests. SHE was diagnosed in 26 (65%) of 40 patients. Of these 26 patients, 14 patients were randomized to treatment group (lactulose 30-60 ml/day for three months, SHE-L) and 12 patients to no treatment group (no lactulose, SHE-NL). Psychometric tests were repeated in all patients in both groups and in six patients with no SHE (group NSHE, N = 14) after three months. The mean scores and number of the abnormal psychometric tests at entry were significantly higher in patients in groups SHE-L and SHE-NL than in patients in group NSHE; however, there was no significant difference between SHE-L and SHE-NL. The mean number of the abnormal psychometric tests decreased in patients in group SHE-L after three months of treatment with lactulose (2.9 +/- 0.9 vs 0.8 +/- 1.2; P = 0.004); however, there was no change in patients in group SHE-NL after three months (3.7 +/- 1.5 vs 3.5 +/- 1.3; P = NS). While SHE improved in 8 of 10 patients in group SHE-L, none of the patients in group SHE-NL improved after three months of follow-up (P < 0.001). Two patients in group SHE-NL also developed overt encephalopathy during the study period. We conclude that lactulose treatment in cirrhotic patients with SHE is effective.
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Dhiman
authors.forename: M S
authors.initials: MS
authors.lastname: Sawhney
authors.forename: Y K
authors.initials: YK
authors.lastname: Chawla
authors.forename: G
authors.initials: G
authors.lastname: Das
authors.forename: S
authors.initials: S
authors.lastname: Ram
authors.forename: J B
authors.initials: JB
authors.lastname: Dilawari
mesh_terms: D000328:Adult; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D011581:Psychological Tests; D016896:Treatment Outcome
chemical_list: D007792:Lactulose