Lactitol in the Prevention of Recurrent Hepatic Encephalopathy in Shunted Cirrhotic Patients. Preliminary Results of a Controlled Trial

Since 1966 [1], lactulose has been the main treatment for episodes of hepatic encephalopathy (HE). The rationale for the use of lactulose in treating this condition was initially based on the acidification of the intestinal tract content following oral administration of the drug. Low colonic pH leads to the creation of a pH gradient between the intestinal lumen and the extracellular fluid which favors the trapping of ammonia and other “toxins.” Additional beneficial properties of lactulose may include its favoring of the incorporation of ammonia in the bacterial proteins, its cathartic effect, and its antiendotoxic effect [2]. Even if its precise mode of action is uncertain, lactulose has been reported effective in the treatment of HE in a number of controlled and uncontrolled clinical investigations [2]. Moreover, lactulose is now accepted as the drug of choice for the management of recurrent or chronic HE. These two conditions are characterized by neurological and psychiatric alterations which occur spontaneously or after minimal precipitating events in patients with advanced cirrhosis and portal-systemic shunting.