Comparing Probiotics Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy: Probiotics Plus Lactulose with Lactulose in Treatment of Overt Hepatic Encephalopathy

Omer Hassaan Aftab Ahmad; Amat Amtul Hafeez; Aiman Asif; Ammarah Amjad; Mehwish Tayyab; Sidra Mumal; Mashhood Ali

doi:10.54393/pjhs.v6i6.2871

Authors

Omer Hassaan Aftab Ahmad Department of Gastroenterology and Hepatology, Omer Diagnostics and Specialists Clinics, Islamabad, Pakistan
Amat Amtul Hafeez Department of Pharmacology, Narowal Medical College, Narowal, Pakistan
Aiman Asif Muhammad Islam Medical and Dental College, Islamabad, Pakistan
Ammarah Amjad Department of Pharmacology, Hazrat Bari Imam Sarkar Medical and Dental College, Islamabad, Pakistan
Mehwish Tayyab Department of Pharmacology, Hazrat Bari Imam Sarkar Medical and Dental College, Islamabad, Pakistan
Sidra Mumal Department of Pharmacology, Islamic International Medical College, Riphah University, Rawalpindi, Pakistan
Mashhood Ali Pakistan Institute of Medical Sciences, Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i6.2871

Keywords:

Ammonia, Hepatic Encephalopathy, Lactulose, Liver Cirrhosis

Abstract

A neuropsychiatric condition known as hepatic encephalopathy (HE) is brought on by liver malfunction, which accumulates poisons like ammonia and impairs brain activity. Objectives: To compare the viability of combining probiotics with lactulose versus utilizing lactulose alone within the treatment of obvious hepatic encephalopathy. Methods: This quasi-experimental study took place in the Gastroenterology and Hepatology Department at the Pakistan Institute of Medical Sciences in Islamabad from August 2019 to January 2020. A total of 160 patients diagnosed with overt HE were included and divided into two groups. Group A received a combination of probiotics and lactulose, while Group B received lactulose alone. Treatment outcomes were evaluated over six months based on improvement in HE symptoms, Model for End-Stage Liver Disease (MELD) scores, length of hospital stay, and potential precipitating factors. Results: The mean age of participants was 44.08 ± 11.31 years. Group A comprised 64 males (80%) and 16 females (20%), while Group B had 30 male (37.5%) and 50 female (62.5%). The MELD scores were comparable between groups (p=0.648). However, the mean hospital stay was significantly shorter in Group A (2.34 ± 0.56 days) than in Group B (2.42 ± 0.63 days; p<0.05), indicating enhanced recovery in the combination therapy group. Conclusions: The addition of probiotics to lactulose significantly improves clinical outcomes in patients with overt hepatic encephalopathy by reducing hospital stay and enhancing treatment efficacy.

References

Xu YX, Wang H, Hu KR. Progress in Pathogenesis and Treatment of Type a Hepatic Encephalopathy in Acute Liver Failure: A Comprehensive Review. Pharmacology Discovery. 2024; 4(1): 1. doi: 10.53388/PD202404001.

Dong QY, Cao YB, Huang HW, Li D, Lin Y, Chen HJ. Metabolic Disorder and Functional Disturbance in the Central Executive Network in Minimal Hepatic Encephalopathy. Cerebral Cortex. 2024 Feb; 34(2): bhae036. doi: 10.1093/cercor/bhae036.

Bajaj JS, Fagan A, White MB, Wade JB, Hylemon PB, Heuman DM et al. Specific Gut and Salivary Microbiota Patterns Are Linked with Different Cognitive Testing Strategies in Minimal Hepatic Encephalopathy. Official Journal of the American College of Gastroenterology. 2019 Jul; 114(7): 1080-90. doi: 10.14309/ajg.0000000000000102.

Ohikere K and Wong RJ. Hepatic Encephalopathy: Clinical Manifestations. Clinics in Liver Disease. 2024 May; 28(2): 253-63. doi: 10.1016/j.cld.2024.01.005.

Llansola M, Arenas YM, Sancho-Alonso M, Mincheva G, Palomares-Rodriguez A, Doverskog M et al. Neuro-inflammation Alters GABAergic Neurotransmission in Hyperammonemia and Hepatic Encephalopathy, Leading to Motor Incoordination. Mechanisms and Therapeutic Implications. Frontiers in Pharmacology. 2024 Mar; 15: 1358323. doi: 10.3389/fphar.2024.1358323.

Tejpal S, Sharma SK, Sharma A, Sharma S. A Comprehensive Review on Hepatic Encephalopathy: Pathophysiology, Symptoms, Epidemiology, Classification, Diagnosis and Treatment. Journal for Research in Applied Sciences and Biotechnology. 2024; 3(3): 170-80. doi: 10.55544/jrasb.3.3.27.

Elbadry M, Baki AA, Bakr A, Elhamrawy EA, Abdel-Tawab H, Aish A et al. Covert Hepatic Encephalopathy: A Neglected Topic—A Narrative Review. Egyptian Liver Journal. 2024 Jul; 14(1): 59. doi: 10.1186/s43066-024-00364-1.

Bauer-Estrada K, Sandoval-Cuellar C, Rojas-Muñoz Y, Quintanilla-Carvajal MX. The Modulatory Effect of Encapsulated Bio-actives and Probiotics on Gut Microbiota: Improving Health Status Through Functional Food. Food and Function. 2023; 14(1): 32-55. doi: 10.1039/D2FO02723B.

Piccioni A, Covino M, Candelli M, Ojetti V, Capacci A, Gasbarrini A et al. How Do Diet Patterns, Single Foods, Prebiotics and Probiotics Impact Gut Microbiota? Microbiology Research. 2023 Mar; 14(1): 390-408. doi: 10.3390/microbiolres14010030.

Sharma BC, Sharma P, Lunia MK, Srivastava S, Goyal R, Sarin SK. A Randomized, Double-Blind, Controlled Trial Comparing Rifaximin Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy. Official Journal of the American College of Gastroenterology. 2013 Sep; 108(9): 1458-63. doi: 10.1038/ajg.2013.219.

Rahimi RS, Brown KA, Flamm SL, Brown Jr RS. Overt Hepatic Encephalopathy: Current Pharmacologic Treatments and Improving Clinical Outcomes. The American Journal of Medicine. 2021 Nov; 134(11):1330-8. doi: 10.1016/j.amjmed.2021.06.007.

Pervaiz F, Hyder A, Naeem J, Haide Z, Ghilzai D. Comparison of the Effectiveness of Rifaximin Plus Lactulose versus Lactulose Alone in Overt Hepatic Encephalopathy in Terms of Complete Reversal. Journal of Fatima Jinnah Medical University. 2024 Apr; 18(01): 6-9.

Peeyush D and Pradhan B. Randomized Controlled Trial of Lactulose and Lactulose with Probiotic in the Treatment of Minimal Hepatic Encephalopathy in Chronic Liver Disease. Birat Journal of Health Sciences. 2023; 8(3) :2082-9. doi: 10.62065/bjhs464.

Wang MW, Ma WJ, Wang Y, Ma XH, Xue YF, Guan J et al. Comparison of the Effects of Probiotics, Rifaximin, and Lactulose in the Treatment of Minimal Hepatic Encephalopathy and Gut Microbiota. Frontiers in Microbiology. 2023 Mar; 14: 1091167. doi: 10.3389/fmicb.2023.1091167.

Shavakhi A, Hashemi H, Tabesh E, Derakhshan Z, Farzamnia S, Meshkinfar S et al. Multistrain Probiotic and Lactulose in the Treatment of Minimal Hepatic Encephalopathy. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 2014 Aug; 19(8): 703.

Abd-Elsalam S, El-Kalla F, Elwan N, Badawi R, Hawash N, Soliman S et al. A Randomized Controlled Trial Comparing Nitazoxanide Plus Lactulose with Lactulose Alone in Treatment of Overt Hepatic Encephalopathy. Journal of Clinical Gastroenterology. 2019 Mar; 53(3): 226-30. doi: 10.1097/MCG.0000000000001040.

Butt NI, Butt UI, Kakar AA, Malik T, Siddiqui AM. Is Lactulose Plus Rifaximin Better Than Lactulose Alone in the Management of Hepatic Encephalopathy? Journal of College of Physicians and Surgeons Pakistan. 2018 Feb; 28(2): 115-7. doi: 10.29271/jcpsp.2018.02.115.

Rehman HA, Nazar T, Aziz B, Farooq H, Nazar N. Role of Probiotics in Secondary Prophylaxis of Hepatic Encephalopathy. Pakistan Journal of Medical and Health Sciences. 2023 Jun; 17(06): 18-. doi: 10.53350/pjmhs202317618.

Riaz A, Mustafa K, Saeed R. Comparison of Lactulose Plus Rifaxamin Versus Lactulose Alone for Hepatic Encephalopathy. International Journal of Advanced Biotechnology and Research. 2018 Jan; 9(1): 2388-91.

Hussain M, Akhtar L, Ghafoor MB. Hepatic Encephalopathy: To Compare the Efficacy of Lactulose Alone and Lactulose with Rifaxamin in Patients of Hepatic Encephalopathy. The Professional Medical Journal. 2017 Jul; 24(07): 947-51. doi: 10.29309/TPMJ/2017.24.07.1087.

Hussain T, Sattar M, Mustafa S, Batool U, Iqbal S, Hussain BH et al. Comparing Efficacy of Rifaximin Plus Lactulose Vs. Lactulose Alone in Treating Hepatic Encephalopathy. Journal of Rawalpindi Medical College. 2020 Dec; 24(4). doi: 10.37939/jrmc.v24i4.1418.