[Long-term efficacy of lactulose in patients with subclinical hepatic encephalopathy].
OBJECTIVE
To observe the long-term clinical efficacy of lactulose in patients with subclinical hepatic encephalopathy (SHE) and the natural history of this disease.


METHODS
Patients with SHE diagnosed with psychometric tests (number connection test and digit symbol test) were randomly allocated to control group (Cg), short-term (Stg) and long-term treatment group (Ltg), respectively. Lactulose (15 - 90 ml/day) was orally given to 21 patients in Stg for 8 weeks, and 22 in Ltg for 24 weeks.The drug was not given to 21 patients in Cg. Psychometric test, somatosensory evoked potentials (SEP) and venous blood ammonia concentration (BA) were investigated before and after treatment at 8 week intervals for 6 months of follow-up.


RESULTS
In Ltg, psychometric tests were significantly improved, BA was lowered and N(50) peak latency in SEP was not prolonged as compared with those in Cg, in which psychometric tests and N(50) peak latency gradually worsened during the follow-up. After 8 weeks of treatment, psychometric tests, BA and N(50) peak latency were significantly improved in Stg, but at week 24 they were deteriorated after cessation of treatment. The development of clinical hepatic encephalopathy was more frequent in Cg (40%) and Stg (30%) than in Ltg (5%). One patient each was not followed up after week 24 in Cg and Stg, respectively and 2 patients in Ltg stopped lactulose because of severe diarrhea.


CONCLUSIONS
In patients with SHE, long-term treatment with lactulose could lower BA, improve psychometric tests, prevent SEP from getting worse, and eventually cut down the occurrence rate of clinical hepatic encephalopathy.
Nie
Yu-Qiang
YQ
Department of Gastroenterology, The First Municipal Hospital of Guangzhou, Guangzhou 510180, China. whsha@163.net
Zeng
Zheng
Z
Li
Yu-Yuan
YY
Sha
Wei-Hong
WH
Ping
Li
L
Dai
Shou-Jun
SJ
D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000188:drug therapy*; D006801:Humans; D007361:Intelligence Tests; D007792:Lactulose / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D007792:Lactulose; D000641:Ammonia