Is Lactulose Effective Therapy for Hepatic Encephalopathy?

Hepatic encephalopathy is a neuropsychiatric syndrome that often complicates acute or chronic advanced liver disease. Manifestations range from subclinical neuropsychiatric changes to focal neurologic signs or frank coma. Traditionally, treatment involves antibiotics to reduce ammonia-producing colonic bacteria and lactulose to acidify the colonic lumen, to reduce ammonia absorption, and to improve stool clearance.

When lactulose was first introduced, results from placebo-controlled trials showed no benefit, but it became the standard of care as studies indicated that it was as efficacious as neomycin, but associated with fewer side effects. Since that time, few studies have compared lactulose with either placebo or antibiotic therapy. In th…