mechanism by which lactulose improve hepatic encephalopathy

Q; Lactulose improves hepatic encephalopathy by? (select one)

A) Acidification of the gut lumen

B) Alkalization of the gut lumen

Answer: A

• The conversion of Lactulose to lactic acid results in acidification of the gut lumen. This favors the conversion of NH4 + to NH3 and the passage of NH3 from tissues into the lumen.
• Gut acidification inhibits ammoniagenic coliform bacteria, leading to increased levels of nonammoniagenic lactobacilli.
• Lactulose also works as a cathartic, reducing colonic bacterial load.

#GI

#hepatology

References:

1. Shuliat'ev IS, Il'chenko LIu, Vinnitskaia EV, Petrakov AV, Sil'verstrova SIu. Laktuloza v lechenii pechenochnoĭ éntsefalopatii u bol'nykh tsirrozom pecheni [Lactulose in treatment of hepatic encephalopathy in patient with liver cirrhosis]. Eksp Klin Gastroenterol. 2002;(5):38-41, 127. Russian. PMID: 12619575.

2. Luo M, Li L, Lu CZ, Cao WK. Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: a meta-analysis. Eur J Gastroenterol Hepatol. 2011 Nov;23(12):1250-7. doi: 10.1097/MEG.0b013e32834d1938. PMID: 21971378.

3. Hudson M, Schuchmann M. Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence. Eur J Gastroenterol Hepatol. 2019 Apr;31(4):434-450. doi: 10.1097/MEG.0000000000001311. PMID: 30444745; PMCID: PMC6416096.