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Colegio de Medicina Interna de México.

2015, Number 4

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Med Int Mex 2015; 31 (4)

Meta-analysis: Primary prophylaxis of clinically overt hepatic encephalopathy with lactulose in patients with liver cirrhosis and acute GI bleeding

Andrade-Castellanos CA, Colunga-Lozano LE

Language: Spanish
References: 28
Page: 380-388
PDF size: 484.58 Kb.


ABSTRACT

Background: Overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Since neurocognitive deficits following an episode of HE may not be fully reversible, prophylactic therapy of overt HE is warranted.
Objective: To evaluate whether the use of lactulose reduce the incidence of clinically overt hepatic encephalopathy in bleeding cirrhotic patients.
Material and method: We searched MEDLINE, EMBASE, and CENTRAL for randomized controlled trials comparing lactulose with placebo or no intervention in adult patients with liver cirrhosis and acute GI bleeding. To be eligible, studies must assess the efficacy of lactulose in preventing an episode of overt hepatic encephalopathy as primary prophylaxis. Two reviewers extracted data, assessed risk of bias and summarized strength of evidence using the GRADE approach.
Results: Low quality evidence from two trials suggested that lactulose significantly reduce the incidence of overt HE in bleeding cirrhotic patients (relative risk, 0.30 [95% CI, 0.14 to 0.64, p=0.002] I2=0%). Compared with no intervention, lactulose significantly increased the incidence of diarrhea (relative risk, 10.23 [95% CI, 1.31 to 79.84, p=0.03]; I2=0%).
Conclusions: The available evidence suggests a potential effect of lactulose in the prevention of overt hepatic encephalopathy in bleeding cirrhotic patients. Further research is necessary to clarify effects on long-term clinical outcomes and safety.


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