Efficacy of lactulose in cirrhotic patients with subclinical hepatic encephalopathy

To investigate the role of lactulose in the treatment of cirrhotic patients with subclinical hepatic encephalopathy (SHE), 40 cirrhotic patients, 33 m ales and 7 females, were included in the study. The diagnosis of SHE was ma de by quantitative psychometric tests including the number connection test (NCT), figure connection test (FCT) parts A and B, and two performance subt ests of Wechsler adult intelligence scale, ie, picture completion (PC) and block design (BD) tests. SHE was diagnosed in 26 (65%) of 40 patients. Of t hese 26 patients, 14 patients were randomized to treatment group (lactulose 30-60 ml/day for three months, SHE-L) and 12 patients to no treatment grou p (no lactulose, SHE-NL). Psychometric tests were repeated in all patients in both groups and in six patients with no SHE (group NSHE, N = 14) after t hree months. The mean scores and number of the abnormal psychometric tests at entry were significantly higher in patients in groups SHE-L and SHE-NL t han in patients in group NSHE; however, there was no significant difference between SHE-L and SHE-NL. The mean number of the abnormal psychometric tes ts decreased in patients in group SHE-L after three months of treatment wit h lactulose (2.9 +/- 0.9 vs 0.8 +/- 1.2; P = 0.004); however, there was no change in patients in group SHE-NL after three months (3.7 +/- 1.5 vs 3.5 /-: 1.3; P = NS). While SHE improved in 8 of 10 patients in group SHE-L, no ne of the patients in group SHE-NL improved after three months of follow-up (P < 0.001). Two patients in group SHE-NL also developed overt encephalopa thy during the study period. We conclude that lactulose treatment in cirrho tic patients with SHE is effective.