Lactulose: a prebiotic, laxative and detoxifying agent

Abstract

According to recent studies, lactulose is also effective in treating post-partum constipation and is safe to use during pregnancy. Because of its various benefits in multiple disorders, the use of lactulose is not limited to only constipation and hepatic encephalopathy. [...]it is available as a food or drink additive in some countries (e.g. Italy, Japan and the Netherlands) [7]. Because of this osmotic action, the water content of stools increases and stools becomes soft. When lactulose reaches the colon, it is degraded by colonic bacteria to various short-chain fatty acids such as lactic acid, pyruvic acid, etc. Because of the laxative action of lactulose, trapped ammonium ions are pushed out of the colon and excreted through the faeces (Fig. 2). Therapeutic efficacy in hepatic encephalopathy The American Association for the Study of Liver Diseases and European Association for the Study of the Liver guidelines for the management of HE in chronic liver disease recommend lactulose as a first choice for the treatment of episodic overt HE [10]. In clinical practice, the management of cirrhotic HE can be classified as: * the treatment of minimal hepatic encephalopathy (MHE; i.e. no apparent symptoms of HE); * primary prophylaxis of overt HE (i.e. apparent symptoms of HE without a history of HE episode ± MHE); * secondary prophylaxis of overt HE (i.e. patients who have recovered from an HE episode). Minimal hepatic encephalopathy In a study in patients with extra-hepatic portal vein obstruction, lactulose improved MHE in 53% of patients after 3 months...