Lactulose improves psychometric testing in cirrhotic patients with subclinical encephalopathy.

BACKGROUND

Therapeutic trials suggest that lactulose is an effective treatment of acute and chronic encephalopathy in cirrhotic patients.

AIM AND METHODS

As it is likely that portal-systemic shunting and hepatocellular dysfunction are associated with some degree of neurological dysfunction, 14 patients with cirrhosis and documented portal-systemic shunting, but without detectable encephalopathy, were randomized to treatment with either lactulose 20 g t.d.s., or lactose 20 g t.d.s. as placebo, for a 15-day period. Monitoring included manually administered and computer-based psychometric testing, the results of which were correlated with a battery of biochemical and functional parameters.

RESULTS

There was no correlation between biochemical or functional parameters and psychometric testing. There was a close correlation between the time required to complete the number connection test and both the number of errors and the duration of errors at sinusoid testing. Lactulose therapy resulted in a significant improvement, assessed by the number connection test and the race track test.

CONCLUSION

Our data suggest that lactulose therapy might improve subclinical hepatic encephalopathy in patients with cirrhosis and portal-systemic shunting.