THE ROLE OF LACTULOSE FOR THE PROPHYLAXIS OF HEPATIC ENCEPHALOPATHY IN PATIENTS WITH ACUTE VARICEAL BLEED

Background: Lactulose, a non-absorbable osmotic laxative, is frequently used in the treatment and prevention of overt hepatic encephalopathy in patients with cirrhosis and acute variceal bleed. Objective: To determine the role of lactulose for the prophylaxis of hepatic encephalopathy in the patients with acute variceal bleed. Material and Methods: This quasi experimental study was conducted at Nishtar Medical University and Hospital Multan from July 2018 to December 2018 after taking ethical approval from institutional review board. All the patients of either gender, fulfilling the inclusion criteria, were included in the study after having informed consent. Complete history and examination were carried out in all patients. All the patients were given lactulose in a dose of 30 ml three times a day. Patients were followed up for the presence of any feature of hepatic encephalopathy for 48 hours after admission by the researchers. All the data was entered and andanalyzed using SPSS version 17. Results: There were 186 patients in total. Males were 60.8% while females were 39.2%. Mean duration of bleed was 49.92+18.78 hours. Overall, hepatic encephalopathy was diagnosed to be present in 20.4% while it was absent in 79.6%. Lactulose failed to prevent hepatic encephalopathy in 21.90% males and 19.50% females (p-value = 0.712). In terms of age, lactulose was ineffective within 48 hours of treatment in 16.30%, 23.10%, 21.30% patients in age groups < 30 years, 31-45 years and > 45 years, respectively (p-value = 0.75). Similarly, lactulose was found to be ineffective in 18%, 19.40% and 23.40% patients at duration of 01, 02 and 03 days of treatment, respectively (p-value = 0.82). Conclusion: Lactulose is effective in the prophylaxis of hepatic encephalopathy in patients with acute variceal hemorrhage.