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The rectal administration of lactulose.

R N Ratnaike, E P Hicks, I G Hislop

Australian and New Zealand Journal of Medicine

|April 1, 1975

Summary

Lactulose colonic washout effectively lowered blood ammonia levels in patients with portal systemic encephalopathy. This treatment also led to significant improvements in electroencephalogram readings, indicating neurological benefit.

Area of Science:

Gastroenterology and Hepatology
Neurology

Background:

Portal systemic encephalopathy (PSE) is a serious complication of liver disease, characterized by elevated blood ammonia levels.
Ammonia's neurotoxic effects contribute to the cognitive and neurological deficits seen in PSE.

Purpose of the Study:

To evaluate the efficacy of lactulose colonic washout in reducing blood ammonia levels in patients with PSE.
To assess the impact of lactulose therapy on electroencephalogram (EEG) findings in PSE patients.

Main Methods:

Six male patients with PSE received lactulose colonic washout (pH 4.5).
Blood ammonia levels and EEG were measured before and after treatment.
A control enema with buffered physiological saline (pH 4.5) was administered to one patient.

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Main Results:

Five out of six patients showed a significant reduction in blood ammonia levels following lactulose washout (P < .025).
The sixth patient experienced an ammonia decrease with saline alone, not further enhanced by lactulose.
EEG improvements correlated directly with the reduction in blood ammonia levels achieved by lactulose.

Conclusions:

Lactulose colonic washout is an effective method for lowering ammonia levels in PSE.
The reduction in ammonia correlates with neurological improvement, as evidenced by EEG changes.