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Lactulose improves cognitive functions and health‐related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy
Author(s) -
Prasad Srinivasa,
Dhiman Radha K.,
Duseja Ajay,
Chawla Yogesh K.,
Sharma Arpita,
Agarwal Ritesh
Publication year - 2007
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.21533
Subject(s) - lactulose , hepatic encephalopathy , medicine , quality of life (healthcare) , cirrhosis , gastroenterology , multivariate analysis of variance , nursing , machine learning , computer science
Minimal hepatic encephalopathy (MHE) has a negative effect on patients' daily functioning. Thus far, no study has investigated the effect of treatment‐related improvement in cognitive functions on health‐related quality of life (HRQOL). We measured psychometric performance by number and figure connection tests parts A and B, picture completion, and block design tests and HRQOL by the Sickness Impact Profile (SIP) of 90 patients with cirrhosis on inclusion into the study and 3 months later. A Z score less than −2 on the neuropsychological (NP) tests was considered abnormal. Sixty‐one (67.7%) patients had MHE. They were randomly assigned in a 1:1 ratio to receive treatment (lactulose) for 3 months (n = 31) or no treatment (n = 30) in a nonblinded design. The mean number of abnormal NP tests decreased significantly in patients in the treated group (baseline, 2.74 [95% CI 2.40‐3.08]; after 3 months, .75 [95% CI .36‐1.16]) compared with patients in the untreated group (baseline, 2.47 [95% CI 2.19‐2.74]; after 3 months, 2.55 [95% CI 2.16‐2.94]); multivariate analysis of variance (MANOVA) for time and treatment, P = 0.001. The mean total SIP score improved among patients in the treated group (baseline, 10.39 [95% CI 9.36‐11.43]; after 3 months, 3.77 [95% CI 2.52‐5.02]) compared with patients in the untreated group (baseline, 10.36 [95% CI 8.98‐11.73]; after 3 months, 10.39 [95% CI 8.36‐12.42]); MANOVA for time and treatment, P = 0.002. Improvement in HRQOL was related to the improvement in psychometry. Conclusion : Treatment with lactulose improves both cognitive function and HRQOL in patients with cirrhosis who have MHE. (H EPATOLOGY 2007;45:549–559.)