Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial

H. O. Conn, C. M. Leevy, Z. R. Vlahcevic, J. B. Rodgers, W. C. Maddrey, L. Seeff, L. L. Levy

Research output: Contribution to journalArticle

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Abstract

A randomized double blind clinical comparison of neomycin and lactulose was performed in 33 cirrhotic patients with chronic portal systemic encephalopathy (PSE) at 7 cooperating hospitals. In order to maintain double blindness, sorbitol syrup was used as a control solution along with neomycin and was compared with lactulose syrup and placebo tablets in a double drug protocol. Twenty nine patients were studied in a crossover investigation in which each received both therapeutic regimens preceded and followed by control periods. Four additional patients received 1 or the other agent, but did not receive both. Serial, semiquantitative assessments were made in all patients of mental status, asterixis, and the trailmaking test (TMT) and electroencephalograms (EEG) and arterial ammonia levels. Both neomycin sorbitol and lactulose were effective in the majority of patients (83 and 90%, respectively). Each of these parameters (mental state, asterixis, TMT, EEG, and NH 3) was improved significantly by neomycin sorbitol and lactulose. The posttreatment levels for each of these measures were similar in the neomycin and lactulose treated groups. Mean stool pH was reduced by neomycin sorbitol to 6.1 and by lactulose to 5.5. This difference was highly significant statistically. Bowel activity was similar in the 2 groups. Both drugs were free of toxicity. These investigations demonstrate that both lactulose and neomycin sorbitol are effective in the treatment of chronic portal systemic encephalopathy.

Original languageEnglish (US)
Pages (from-to)573-583
Number of pages11
JournalGastroenterology
Volume72
Issue number4 1
StatePublished - 1977

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Chronic Brain Damage
Lactulose
Neomycin
Hepatic Encephalopathy
Sorbitol
Dyskinesias
Therapeutics
Electroencephalography
Mentally Ill Persons
Blindness
Ammonia
Pharmaceutical Preparations
Tablets
Placebos

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Conn, H. O., Leevy, C. M., Vlahcevic, Z. R., Rodgers, J. B., Maddrey, W. C., Seeff, L., & Levy, L. L. (1977). Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial. Gastroenterology, 72(4 1), 573-583.

Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial. / Conn, H. O.; Leevy, C. M.; Vlahcevic, Z. R.; Rodgers, J. B.; Maddrey, W. C.; Seeff, L.; Levy, L. L.

In: Gastroenterology, Vol. 72, No. 4 1, 1977, p. 573-583.

Research output: Contribution to journalArticle

Conn, HO, Leevy, CM, Vlahcevic, ZR, Rodgers, JB, Maddrey, WC, Seeff, L & Levy, LL 1977, 'Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial', Gastroenterology, vol. 72, no. 4 1, pp. 573-583.
Conn, H. O. ; Leevy, C. M. ; Vlahcevic, Z. R. ; Rodgers, J. B. ; Maddrey, W. C. ; Seeff, L. ; Levy, L. L. / Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial. In: Gastroenterology. 1977 ; Vol. 72, No. 4 1. pp. 573-583.
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