ABSTRACT
Minimal hepatic encephalopathy [MHE] is common in patients with extrahepatic portal vein obstruction [EHPVO]. There is no study on the treatment of MHE using lactulose in patients with EHPVO. Consecutive EHPVO patients were assessed by psychometric [number connection test [NCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]], and critical flicker frequency [CFF] at inclusion. Patients diagnosed as MHE were treated with lactulose and psychometric tests, CFF, and were reassessed after 3 months. Of the 70 patients screened, the prevalence of abnormal psychometric test was as follows: NCT-A [41%], NCT-B [53%], DST [38%], SDT [40%], and LTT [44%]. Thirty patients [43%] had two or more than two abnormal [>2 SD] psychometry tests. Lactulose improved MHE in 16/30 [53%] of patients after 3 months of treatment. Arterial ammonia decreased after lactulose treatment compared to baseline [83.7 +/- 19.1 vs. 65.1 +/- 19.3 micro mol/l, P=0.001]. A total of 9 [75%] of 12 patients with large spontaneous shunt and 7 [39%] of 18 patients without spontaneous shunt improved with lactulose [P=0.07]. CFF in patients with MHE [n=30] was significantly lower than those without MHE [n=40] [38.1 +/- 2.4 vs. 41.5 +/- 3.1 Hz, P=0.01]. CFF was less than 38 Hz in 21 [70%] of 30 patients before treatment and in 10 [33%] patients after lactulose therapy in MHE patients. All patients could tolerate lactulose without any significant side effects. Four patients [13%] developed transient diarrhea in whom dose needed reduction, 3 [10%] did not like its taste but have continued, and 2 [6%] developed abdominal bloating sensation. Lactulose is effective in the treatment of MHE in patients with EHPVO