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Lactitol in treatment of chronic hepatic encephalopathy

A meta-analysis

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Abstract

The efficacy and side effects of lactitol in the treatment of chronic hepatic encephalopathy was compared to that of other disaccharides in a meta-analysis of published randomized clinical trials (RCTs). The outcomes assessed were: (1) the rate of patients free from episodes of clinically detectable encephalopathy, and (2) the rate of patients free from one or more side effects in the different treatment groups. Four RCTs were eligible for analysis; in three lactitol was compared to lactulose, in one the alternative treatment was lactose in lactase-deficient patients. The methodological quality of these studies was high. Meta-analysis showed that lactitol was as effective as other disaccharides in the treatment of encephalopathy: pooled odds ratio was 0.83, 95% confidence interval was 0.38–1.82. Results were not sensitive to the use of alternative methods of counting and attributing events in these trials. Patients experienced fewer side effects during treatment with lactitol, but the pooled odds ratio was not statistically significant. In all studies lactitol was considered more palatable. Clinical effectiveness of lactitol, in long-term treatment of chronic encephalopathy, is similar to those of lactulose. It seems that lactitol has lower side effects than lactulose. Future RCTs with a double-blind design could be mainly aimed at evaluating the side-effect profile of the two disaccharides.

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Authors and Affiliations

  1. Istituto di Medicina Generale e Pneumologia, Clinica Medica R, Ospedale V. Cervello, University of Palermo, via Trabucco 180, 90146, Palermo, Italy

    Calogero Cammà MD, Felice Fiorello MD, Fabio Tinè MD, Giulio Marchesini MD, Andrea Fabbri MD & Luigi Pagliaro

  2. Istituto di Clinica Medica Generale e Terapia Medica, University of Bologna, Bologna, Italy

    Calogero Cammà MD, Felice Fiorello MD, Fabio Tinè MD, Giulio Marchesini MD, Andrea Fabbri MD & Luigi Pagliaro

Authors
  1. Calogero Cammà MD
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  2. Felice Fiorello MD
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  3. Fabio Tinè MD
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  4. Giulio Marchesini MD
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  5. Andrea Fabbri MD
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  6. Luigi Pagliaro
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This work was supported by grants from the Zyma S. A.

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Cammà, C., Fiorello, F., Tinè, F. et al. Lactitol in treatment of chronic hepatic encephalopathy. Digest Dis Sci 38, 916–922 (1993). https://doi.org/10.1007/BF01295920

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  • DOI: https://doi.org/10.1007/BF01295920

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