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Lactulose plus probiotics fails to improve HE in patients with cirrhosis

HONOLULU — Lactulose in combination with probiotics was ineffective at improving hepatic encephalopathy severity in patients with liver cirrhosis, according to a poster presentation at ACG 2015.

Researchers, including Fauzi Yusuf, MD, department of internal medicine, Syiah Kuala University, Banda Aceh, Indonesia, randomly assigned 49 patients with liver cirrhosis and overt hepatic encephalopathy (HE) to a regimen of either 30 to 60 mL per day of lactulose (n = 17), probiotics (n = 17) or a combination of both (n = 15) for 2 weeks.

“Lactulose is known to be useful in the treatment of acute, chronic or recurrent HE,” the researchers wrote. “Probiotics improve minimal [HE]. We studied lactulose, probiotics and combination of both in the treatment of HE in patients with liver cirrhosis.”

Overall, researchers found significant improvements in multiple liver function biomarkers. However, there was no significant improvement in the severity of HE among patients in the lactulose alone group (n = 2; 11.76%), probiotics group (n = 0; 0%) or the combination group (n = 1; 6.6%).

“Our study showed no significant improvement in the severity of HE,” the researchers wrote.

Improvements were seen in various biomarkers including serum albumin level for the lactulose alone group (2.5 ± 0.43 vs. 3.31 ± 0.34 g/dL), probiotics group (2.55 ± 0.61 vs. 3.26 ± 0.4 g/dL) and combination group (2.46 ± 0.43 vs. 3.34 ± 0.27 g/dL); in total bilirubin for the lactulose group (6.15 ± 8.23 vs. 4.8 ± 7.06 mg/dL), probiotics group (3.21 ± 2.39 vs. 2.36 ± 2.08 mg/dL) and combination group (4.16 ± 6.18 vs. 3.21 ± 5.54 mg/dL); and serum ammonia in the lactulose alone group (198.29 ± 21.44 vs. 136.11 ± 19.99 µg/dL), probiotics group (197.35 ± 22.2 vs. 143.76 ± 29.73 µg/dL) and combination group (188.53 ± 26.04 vs. 129.93 ± 22.41 µg/dL). Improvements were also seen in alanine aminotransferase and aspartate aminotransferase levels for all three groups.

“Our study also revealed significant improvement in liver functions biomarkers,” the researchers concluded. “The latter implies that lactulose, probiotics or combination of both are of some benefit in the treatment of HE in patients with liver cirrhosis.”

Reference:

Yusuf F, et al. Abstract P1854. Presented at: ACG; Oct. 16-21, 2015; Honolulu.

Disclosures: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.