Abstract

RANDOMIZED CONTROLLED TRIAL OF LACTULOSE AND LACTULOSE PLUS PROBIOTICS IN THE TREATMENT OF MINIMAL HEPATIC ENCEPHALOPATHY

Author(s): Mayank Sharma1, Sanjay Bhat2, Kalyan Dutt3, Pulkit Sharma4, Jasra Ali Bhat5

ABSTRACT: BACKGROUND AND AIM: Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with lactulose and probiotics has shown some benefit. We compared lactulose and a combination of lactulose plus probiotics in the treatment of MHE. PATIENTS AND METHODS: Fifty cirrhotic patients without overt encephalopathy were evaluated by psychometry (Number connection tests, Block design test and Digit symbol test). MHE was diagnosed by abnormal psychometry. Patients were randomized to receive lactulose [group 1 (n = 25): dose 30–60 ml/day], and probiotics plus lactulose [group 2 (n = 25) same dose of lactulose plus probiotic one capsule three times/ day, each capsule contained Streptococcus faecalis 60 million, Clostridium butyricum 4 million, Bacillus mesentricus 2 million, lactic acid bacillus 100 million]. Response was defined by normalization of the abnormal test parameters at six weeks treatment. RESULTS: MHE was diagnosed in 50 patients. Of the 50 patients, all had abnormal psychometry tests. Significant improvement was seen in abnormal psychometry tests in lactulose alone and lactulose plus probiotics groups after treatment. Normalization of abnormal psychometry was seen in 63%, and 60% of patients treated with lactulose alone and lactulose plus probiotics groups, respectively. CONCLUSION: All the patients with cirrhosis had MHE. Lactulose alone or combinations of both lactulose plus probiotic are equally effective in the treatment of MHE.