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[Megacolon during treatment with lactulose]
H J van der Vliet1, A A van Bodegraven
1Afd. Inwendige Geneeskunde, VU Medisch Centrum, De Boelelaan 1117, 1081 HV Amsterdam. jj.vandervliet@vumc.nl
Nederlands Tijdschrift Voor Geneeskunde
|June 9, 2004
Summary
Lactulose, a common laxative, can cause dangerous bowel dilation due to gas production, especially in patients with slow digestion. This rare complication necessitates surgical intervention and highlights potential risks associated with lactulose use.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Lactulose is a widely prescribed osmotic laxative for constipation.
- It is metabolized in the colon to produce short-chain fatty acids, hydrogen, and carbon dioxide.
Observation:
- Two elderly female patients (88 and 82 years old) developed severe, life-threatening bowel dilation while on lactulose therapy for constipation.
- Both patients required surgical intervention.
Findings:
- One patient had underlying bowel cancer, with a successful surgical outcome.
- The second patient had no mechanical obstruction but unfortunately died from respiratory insufficiency post-aspiration.
- Lactulose-induced gas production can lead to non-toxic megacolon, particularly in individuals with delayed intestinal transit.
Implications:
- This case series highlights a rare but serious adverse effect of lactulose, emphasizing the need for careful patient selection and monitoring.
- Physicians should be aware of the potential for lactulose to cause significant bowel distension, especially in vulnerable populations.
- Further investigation into the mechanisms and risk factors for lactulose-induced megacolon may be warranted.