Lactulose versus lactitol in acute hepatic encephalopathy (HE).

  • Shahid Rasool   Madinah Hospital Faisalabad.
  • Salman Azhar Madinah Teaching Hospital, University of Faisalabad, Faisalabad.
  • Talha Munir Mayo Hospital Lahore.
  • Mian Sajjad Ahmad KEMU, Mayo Hospital Lahore.
  • Rizwan Abbas Mayo Hospital Lahore.
  • Rizwan Abbas
  • Muhammad Ahsan Government General Hospital, Faisalabad.
Keywords: Cirrhosis, Hepatic Encephalopathy, Lactulose, Lactitol


Hepatic encephalopathy (HE), a syndrome observed in some patients with cirrhosis, with depressed level of consciousness. Lactulose as well as lactitol has been used in the treatment of HE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects and better tolerated. However, literature showed equal efficacy of both drugs. So we conducted this trial to find better drug to implement its use in future. Objective: To compare the effectiveness of lactulose and lactitol in patients with acute hepatic encephalopathy. Study Design: Randomized Controlled Trial. Setting: Department of Medicine OPD and Emergency (East, West, North, South), Mayo Hospital, Lahore. Period: 6 Months June 2017 to Dec 2017. Material & Methods: 570 patients were included through non-probability, consecutive sampling after informed consent. Initial grade of HE was assessed and patients were randomly divided in two groups by using lottery method i.e. lactulose or lactitol. Patients were admitted to ward for management and kept under observation for 5 days. After 5 days, HE grades was measured again, then improvement in grade of HE (effectiveness) was measured. All data was entered and analyzed by using SPSS version 21.0. Chi-square was applied to compare both groups for effectiveness taking p-value≤0.05 as significant. Results: In this study the mean age of the patients was 44.22 ±11.81 years, the male to female ratio of the patients was 2.4:1. The mean duration of the cirrhosis of the patients was 3.73±1.61 months. In our study the effectiveness was achieved in 538 (94.39%) patients, out of which 263 cases were from lactulose group and 275 were from lactitol group and the difference was significant (p<0.0.5). Conclusion: Our study results concluded that Lactitol is better choice for the treatment of patients with acute hepatic encephalopathy as compared to lactulose. More efficacy was achieved in lactitol group patients than in lactulose group patients.

Author Biographies

Shahid Rasool,   Madinah Hospital Faisalabad.

MBBS, FCPS (Gastro)

Consultant Gasteroentologist

Salman Azhar, Madinah Teaching Hospital, University of Faisalabad, Faisalabad.

MBBS, FCPS (Medicine)

Assistant Professor of Medicine

Talha Munir, Mayo Hospital Lahore.

MBBS, FCPS (Medicine)

Assistant Professor 

Department of Medicine

Mian Sajjad Ahmad, KEMU, Mayo Hospital Lahore.

MBBS, FCPS (Gastro)

Consultant Gasteroentologist

Assistant Professor

Rizwan Abbas, Mayo Hospital Lahore.

FCPS Medicine


Rizwan Abbas

Medical Officer and PGR FCPS medicine, Mayo Hospital Lahore

Muhammad Ahsan, Government General Hospital, Faisalabad.


Medical Officer Pediatric Medicine