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Cochrane systematic review highlights the importance of lactulose in the management of hepatic encephalopathy
  1. Anna Sutherland1,
  2. Faeqa Hami2 and
  3. James Maggs3
  1. 1Sue Ryder Hospice, Henley-on-Thames, UK
  2. 2Florence Nightingale Hospice, Stoke Mandeville Hospital, Aylesbury, UK
  3. 3Department of Gastroenterology, Stoke Mandeville Hospital, Aylesbury, UK
  1. Correspondence to Dr Anna Sutherland, Sue Ryder Hospice, Joyce Grove, Nettlebed, Henley-on-Thames RG9 5DF, UK; annasutherland{at}

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Dear Editor,

The treatment of hepatic encephalopathy in patients, whose liver disease has reached a palliative stage, has been particularly challenging, given the low levels of evidence, increasing range of therapeutic options (including rifaximin) and the difficulties in managing patients when they lose the ability to swallow.

However, a recent Cochrane Systematic Review ‘Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis’1 has recently highlighted significant benefits of lactulose in the management of hepatic encephalopathy. This updated review, which had previously found ‘no evidence to supporting the use of disaccharides’,2 identified 38 randomised controlled trials (RCTs) with 1828 participants. The review found that non-absorbable disaccharides have been demonstrated to reduce mortality (RR 0.59, 95% CI 0.40 to 0.87; 1487 participants; 24 RCTs; I2=0%; moderate quality evidence when all RCT data were included in analysis). However, more importantly for the quality of life of palliative care patients, it also demonstrated that hepatic encephalopathy improved (RR 0.58, 95% CI 0.50 to 0.69; 1415 …

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  • Competing interests JM reports grants from NORGINE during the conduct of the study.

  • Provenance and peer review Not commissioned; internally peer reviewed.