Efficacy of lactulose in the prophylaxis of hepatic encephalopathy in cirrhotic patients presenting gastrointestinal bleeding.
BACKGROUND
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.


METHODS
A systematic review of the literature using the Medline scientific database. Only randomized controlled clinical trials evaluating the efficacy of lactulose for HE prophylaxis in cirrhotic patients with gastrointestinal bleeding were included.


RESULTS
The incidence of HE in the intervention group was 7%, while the control group was 26% (p=0.01). There was no significant difference in the incidence of mortality in the group treated with lactulose compared to the group that was not treated (p=0.48).


CONCLUSIONS
Administering lactulose to cirrhotic patients with upper gastrointestinal bleeding reduces the incidence of hepatic encephalopathy.
Hospital Ana Costa, Hospital Ana Costa, General Surgery, Santos SP , Brazil, Medical degree from Faculdade de Ciências Médicas de Santos. Resident Physician in General Surgery at Hospital Ana Costa, Santos, SP, Brazil.
Felipe Toyama
FT
Aires
Faculdade de Ciências Médicas de Santos, Faculdade de Ciências Médicas de Santos, Santos SP , Brazil, Medical degree from Faculdade de Ciências Médicas de Santos, Santos, SP, Brazil.
Paola Teruya
PT
Ramos
Associação Médica Brasileira, São Paulo SP , Brazil, PhD from Universidade de São Paulo. Coordinator of the Diretrizes Project, Associação Médica Brasileira and the Conselho Federal de Medicina, São Paulo, SP, Brazil.
Wanderley Marques
WM
Bernardo
D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D007792:Lactulose