Efficacy of oral L-ornithine-L-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study

Despite steady progress in therapeutics of liver disease, portal systemic encephalopathy remains to be a great challenge for clinicians because of the heterogeneity of neuropsychiatric symptoms, multiple risk factors and complexity on achieving a sustained response. We aimed to evaluate the efficacy of L-Ornithin, L-Aspartate versus lactulose in Mexican patients with hyperammonemic hepatic encephalopathy. A total of 20 patients were randomly allocated to receive either lactulose (n = 10) or L-ornithine - L-aspartate (n = 10) for 2 weeks. At baseline, patients of both groups were comparable in age (64 ± 7 versus 60 ± 6) and degree of hepatic failure according to the Child-Pugh scale (9.2 ± 1.3 versus 9.2 ± 1.1). A significant decrease in ammonia levels was observed both in the lactulose group (120.4 ± 8.1 versus 91.4 ± 10, p < 0.05) and in the LOLA group (141.6 ± 9.1 versus 96.9 ± 9.3, p < 0.05). Moreover, in patients who received LOLA a significant improvement was observed in mental status (1.0 ± 0.14 versus 0.4 ± 0.16, p < 0.05), Number Connection Test (184 ± 43 versus 88 ± 7, p < 0.05), asterixis (14.6 ± 2.8 versus 6.7 ± 1.5, p < 0.05), as well as EEG findings (6.8 ± 0.6 versus