Year 2017 / Volume 109 / Number 10
Letter to the Editor
Lactulose enemas in the treatment of hepatic encephalopathy. Do we help or harm?

736-737

DOI: 10.17235/reed.2017.5106/2017

Ana de Lorenzo-Pinto, Raquel García-Sánchez, Almudena Lorenzo-Salinas,

Abstract
The administration of lactulose enemas instead of or in combination with oral lactulose is common practice in patients with hepatic encephalopathy. Lactulose is a non-absorbable disaccharide that is catabolized by the bacterial flora to short chain fatty acids (e.g., lactic acid and acetic acid) which lower the colonic pH. This pH favors the formation of non-absorbable NH4+ from NH3, trapping NH4+ in the colon and thus reducing plasma ammonia concentrations. Lactulose therapy is considered as a first-line treatment and can be administered both orally and rectally.
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Comments

03/12/2017 6:05:10
Interesante correspondencia. En países de sudamérica recurrimos al uso de los enemas con lactulosa mas agua en la misma proporción.


References
1. Hepatic encephalopathy in adults: Treatment. UpToDate. Accedido el 23 de mayo de 2017. Disponible en: http://uptodates.bvcscm.csinet.es/contents/hepatic-encephalopathy-in-adults-treatment?source=search_result&search=lactulosa%20encefalopatis&selectedTitle=1~150H6
2. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. Hepatology 2014;60(2):715-35
3. Al Sibae MR, McGuire BM. Current trends in the treatment of hepatic encephalopathy. Ther Clin Risk Manag 2009;5(3):617-26
4. Uribe M, Campollo O, Vargas F, et al. Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind, randomized clinical trial. Hepatology 1987; 7:639
5. Sharluyan A, Stanescu S, Pérez-Caballero Macarrón C. ¿Es prudente seguir utilizando los enemas fosfato?. An Pediatr 2014;81(6):e72-3
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de Lorenzo-Pinto A, García-Sánchez R, Lorenzo-Salinas A. Lactulose enemas in the treatment of hepatic encephalopathy. Do we help or harm?. 5106/2017


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Publication history

Received: 05/06/2017

Accepted: 09/06/2017

Online First: 18/09/2017

Published: 29/09/2017

Article Online First time: 105 days

Article editing time: 116 days


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