In this study, physicians from Denmark assessed the effects of non-absorbable disaccharides (lactulose and lactitol) in patients with hepatic encephalopathy.
The team searched the Cochrane Hepato-Biliary Group controlled trials register, Cochrane Library, Medline, and Embase for relevant studies. They also examined the reference lists of relevant articles, and contacted authors and pharmaceutical companies.
The physicians included 22 randomized trials comparing non-absorbable disaccharides with placebo, no intervention, or antibiotics for hepatic encephalopathy.
The team found that non-absorbable disaccharides reduced the risk of no improvement in patients with hepatic encephalopathy (relative risk 0.62), when compared with placebo or no intervention.
|Non-absorbable disaccharides were inferior to antibiotics.|
|British Medical Journal|
However, 2 high quality trials found no significant effect (0.92).
They found that compared with placebo or no intervention, non-absorbable disaccharides had no significant effect on mortality (0.41).
Furthermore, non-absorbable disaccharides were inferior to antibiotics in reducing the risk of no improvement (1.24) and lowering blood ammonia concentration..
Dr Bodil Als-Nielsen's team concluded, "There is insufficient evidence to support or refute the use of non-absorbable disaccharides for hepatic encephalopathy".
"Antibiotics were superior to non-absorbable disaccharides in improving hepatic encephalopathy, but it is unclear whether this difference is clinically important".
"Non-absorbable disaccharides should not serve as comparator in randomized trials on hepatic encephalopathy".