PMID- 38147599
OWN - NLM
STAT- MEDLINE
DCOM- 20231228
LR  - 20240605
IS  - 1842-1121 (Electronic)
IS  - 1841-8724 (Linking)
VI  - 32
IP  - 4
DP  - 2023 Dec 22
TI  - Prophylactic Lactulose Therapy in Patients with Cirrhosis and Upper 
      Gastrointestinal Bleeding: A Meta-analysis of Randomized Trials.
PG  - 507-512
LID - 10.15403/jgld-4975 [doi]
AB  - BACKGROUND AND AIMS: Lactulose is the first-line drug for both treatment and 
      secondary prophylaxis for overt hepatic encephalopathy (HE). The use of lactulose 
      for the primary prophylaxis of HE in patients with cirrhosis and acute upper 
      gastrointestinal bleeding (AUGIB) has been debated. Hence, we conducted this 
      meta-analysis to assess the role of lactulose in HE prophylaxis in patients with 
      cirrhosis and AUGIB. METHODS: A comprehensive search of literature from inception 
      to December 2022 was performed of three databases for randomized studies 
      comparing lactulose and placebo in patients with cirrhosis and AUGIB. Risk ratios 
      (RR) with 95% confidence intervals were calculated for all the dichotomous 
      outcomes. RESULTS: A total of five studies were included in the final analysis, 
      out of which three studies had a low risk of bias, and two had a moderate risk of 
      bias. Lactulose therapy was associated with a significantly lower risk of OHE 
      compared to placebo, with a RR of 0.38 (0.23-0.62) and a number needed to treat 
      of 6. There was no difference in the risk of mortality between the groups, with a 
      RR of 0.71 (0.29-1.76). The pooled incidence rates of overall adverse events 
      (AEs) and diarrhea with the use of lactulose therapy were 53.2% (42.2- 64.2) and 
      34.7% (17.7-51.7), but a majority did not require drug discontinuation. The 
      certainty of the evidence was moderate to low. CONCLUSIONS: Prophylactic 
      lactulose reduces the incidence of HE after AUGIB but has no effect on mortality. 
      Diarrhea and abdominal discomfort are common AEs but do not need drug 
      discontinuation.
FAU - Roy, Akash
AU  - Roy A
AD  - Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, 
      India. . royakash12@gmail.com.
FAU - Giri, Suprabhat
AU  - Giri S
AD  - Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 
      India. . suprabhatgiri@kem.edu.
FAU - Singh, Ankita
AU  - Singh A
AD  - Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 
      India. anruhikita511991@gmail.com.
FAU - Vaidya, Arun
AU  - Vaidya A
AD  - Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, 
      India. arunvaidyagastro@gmail.com.
FAU - Angadi, Sumaswi
AU  - Angadi S
AD  - Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 
      India. sumaswia@gmail.com.
LA  - eng
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20231222
PL  - Romania
TA  - J Gastrointestin Liver Dis
JT  - Journal of gastrointestinal and liver diseases : JGLD
JID - 101272825
RN  - 4618-18-2 (Lactulose)
SB  - IM
MH  - Humans
MH  - *Lactulose/adverse effects
MH  - Randomized Controlled Trials as Topic
MH  - *Hepatic Encephalopathy/drug therapy/etiology/prevention & control
MH  - Liver Cirrhosis/complications/diagnosis/drug therapy
MH  - Diarrhea
MH  - Gastrointestinal Hemorrhage/drug therapy/etiology/prevention & control
EDAT- 2023/12/26 18:41
MHDA- 2023/12/28 06:42
CRDT- 2023/12/26 15:53
PHST- 2023/04/20 00:00 [received]
PHST- 2023/10/07 00:00 [accepted]
PHST- 2023/12/28 06:42 [medline]
PHST- 2023/12/26 18:41 [pubmed]
PHST- 2023/12/26 15:53 [entrez]
AID - 10.15403/jgld-4975 [doi]
PST - epublish
SO  - J Gastrointestin Liver Dis. 2023 Dec 22;32(4):507-512. doi: 10.15403/jgld-4975.