What is the efficacy of lactulose for the prevention of recurrent overt hepatic encephalopathy?

Updated: May 18, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Lactulose was studied in large randomized trials as secondary prevention against recurrent overt encephalopathy. [49, 50] In the study by Sharma et al, patients who were recovering from hepatic encephalopathy were randomized to receive lactulose (n = 61) or placebo (n = 64). Over a median follow-up of 14 months, 12 patients (19.6%) in the lactulose group developed overt hepatic encephalopathy as compared with 30 patients (46.8%) in the placebo group (P = 0.001). The authors concluded that lactulose effectively prevented the recurrence of overt hepatic encephalopathy in patients with cirrhosis. [49]

Lactulose also appeared to be effective as primary prophylaxis against the development of overt hepatic encephalopathy, [51] although few physicians in the United States would advocate the use of lactulose for this indication.

An updated meta-analysis published in 2013 included these studies and affirmed the utility of lactulose in the management of hepatic encephalopathy. [52]

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