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

  • O. Riggio
  • G. Balducci
  • F. Ariosto
  • M. Varriale
  • M. Merli
  • F. Tremiterra
  • V. Ziparo
  • L. Capocaccia
Conference paper

Abstract

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.

Keywords

Hepatic Encepha Taste Aversion Sweet Taste Hepatic Coma Hepatobiliary Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bircher J, Muller J, Guggenheim P, Haemmerli VP (1966) Treatment of chronic portal-systemic encephalopathy with lactulose. Lancet i: 890–893Google Scholar
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    Conn HO, Lieberthal MM (1979) The hepatic coma syndrome and lactulose. Williams and Wilkins, BaltimoreGoogle Scholar
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    Mutchnick MG, Lerner E, Coun HO (1974) Portal-systemic encephalopathy and portal anastomosis: a prospective, controlled investigation. Gastroenterology 66:1005–1019PubMedGoogle Scholar
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    Bircher J, Buhrer M, Franz K, van Velthuijsen J A (1982) First use of lactitol in the treatment of portal-systemic encephalopathy. Schweiz Med Wochenschr 112: 1306–1307PubMedGoogle Scholar
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    Lanthier PL, Morgan MY (1985) Lactitol in the treatment of chronic hepatic encephalopathy: an open comparison with lactulose. GUT 26: 415–420PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Heidelberg 1987

Authors and Affiliations

  • O. Riggio
    • 1
  • G. Balducci
    • 2
  • F. Ariosto
    • 3
  • M. Varriale
    • 3
  • M. Merli
    • 3
  • F. Tremiterra
    • 2
  • V. Ziparo
    • 2
  • L. Capocaccia
    • 3
  1. 1.Department of Internal MedicineUniversity of L’AquilaL’AquilaItaly
  2. 2.I Department of SurgeryUniversity of RomeRomeItaly
  3. 3.II Department of GastroenterologyUniversity of RomeRomeItaly

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