A randomized-controlled trial to compare the effect of lactulose and probiotics on treatment of minimal hepatic encephalopathy

Objective To compare the effect of lactulose and probiotics on treatment of minimal hepatic encephalopathy(MHE).Methods One hundred twenty patients with MHE were randomized divided into control group treated with standard therapy for hepatic cirrhosis,lactulose group treated with 30-60 ml/twice per day,and probiotics group treated with 110 billion colony forming units twice in a day for 1 months.The levels of arterial ammonia and psychometric tests were used to compare the clinical effect after one month of treatment.Results After one month of treatment,the rate of recovery was 10% in the control group,35% in the lactulose group and 30% in probiotics group.The improvement in the lactulose and probiotics groups was significantly better than that in the control group(P = 0.036).There was no significant change in arterial ammonia levels after therapy in the control group before and after treatment.The arterial ammonia levels in the lactulose and probiotics groups were significantly lower than that in the control group after therapy(P=0.000).However,no significant difference in arterial ammonia levels was found between the lactulose and probiotics groups after therapy.Hepatic encephalopathy was developed in 10(8.26%) of 120 patients in which 7(17.50%) in the control group,1(2.5%) in the lactulose group and 2 in the probiotic group.There was a significant difference between and the treatment groups and control group(P = 0.035).Conclusion Lactulose and probiotics significantly improve MHE and eventually reduce the incidence of hepatic encephalopathy.