title: A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction.
abstract: BACKGROUND
  Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE.
  
  
  METHODS
  A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP).
  
  
  RESULTS
  The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea.
  
  
  CONCLUSIONS
  This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated.
authors.affiliation: Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt. hanaakaraksy@kasralainy.edu.eg.|, 44 Mohei El-Deen Abu El-Ezz Street, Dokki, Cairo, 12311, Egypt. hanaakaraksy@kasralainy.edu.eg.
authors.forename: Hanaa Mostafa
authors.initials: HM
authors.lastname: El-Karaksy
authors.affiliation: Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
authors.forename: Omneya
authors.initials: O
authors.lastname: Afifi
authors.affiliation: Department of Psychiatry, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
authors.forename: Azza
authors.initials: A
authors.lastname: Bakry
authors.affiliation: Department of Neurophysiology, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
authors.forename: Ann Abdel
authors.initials: AA
authors.lastname: Kader
authors.affiliation: Department of Psychiatry, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
authors.forename: Noha
authors.initials: N
authors.lastname: Saber
mesh_terms: D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D004534:Egypt; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology*; D006504:Hepatic Veno-Occlusive Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006785:Hospitals, University; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007792:Lactulose / Q000627:therapeutic use*; D008111:Liver Function Tests; D008297:Male; D009483:Neuropsychological Tests; D010865:Pilot Projects; D011446:Prospective Studies; D011594:Psychometrics; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007792:Lactulose
keywords: P300 event-related potential; children; extrahepatic portal vein obstruction; lactulose; minimal hepatic encephalopathy; neuropsychometric tests