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. 1987 Mar;28(3):255–259. doi: 10.1136/gut.28.3.255

Comparative modes of action of lactitol and lactulose in the treatment of hepatic encephalopathy.

D H Patil, D Westaby, Y R Mahida, K R Palmer, R Rees, M L Clark, A M Dawson, D B Silk
PMCID: PMC1432706  PMID: 3570029

Abstract

Lactitol, an unabsorbed sugar with defined laxative threshold and superior taste properties has been suggested as an alternative to lactulose in the treatment of hepatic encephalopathy. In the present study we have compared the colonic metabolism of the two sugars using an in vitro faecal incubation system. Both sugars were readily metabolised by faecal bacteria producing volatile fatty acids and the metabolism was inhibited by neomycin. The effect of lactitol and lactulose on terminal ileal and colonic pH was monitored in six normal subjects using a radiotelemetry technique. Both sugars significantly lowered right colonic pH (basal -6.51 +/- 0.48 vs lactitol -5.63 +/- 0.50; lactulose -5.18 +/- 0.82, p less than 0.05). The pH of rest of the colon and terminal ileum was unaffected. Neomycin given concurrently with lactulose abolished acidification of right colon. As lactitol and lactulose have similar effects within the colon, lactitol would appear to have a role in the treatment of hepatic encephalopathy. As neomycin antagonises the effect of lactulose in the colon, its concurrent use may be less effective in the treatment of hepatic encephalopathy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agostini L., Down P. F., Murison J., Wrong O. M. Faecal ammonia and pH during lactulose administration in man: comparison with other cathartics. Gut. 1972 Nov;13(11):859–866. doi: 10.1136/gut.13.11.859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bircher J., Haemmerli U. P., Scollo-Lavizzari G., Hoffmann K. Treatment of chronic portal-systemic encephalopathy with lactulose. Report of six patients and review of the literature. Am J Med. 1971 Aug;51(2):148–159. doi: 10.1016/0002-9343(71)90233-6. [DOI] [PubMed] [Google Scholar]
  3. Bircher J., Haemmerli U. P., Trabert E., Largiader F., Mocetti T. The mechanism of action of lactulose in portal-systemic encephalopathy. Non-ionic diffusion of ammonia in the canine colon. Rev Eur Etud Clin Biol. 1971 Apr;16(4):352–357. [PubMed] [Google Scholar]
  4. Bown R. L., Gibson J. A., Sladen G. E., Hicks B., Dawson A. M. Effects of lactulose and other laxatives on ileal and colonic pH as measured by a radiotelemetry device. Gut. 1974 Dec;15(12):999–1004. doi: 10.1136/gut.15.12.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bown R. L., Sladen G. E., Rousseau B., Gibson J. A., Clark M. L., Dawson A. M. A study of water and electrolyte transport by the excluded human colon. Clin Sci. 1972 Dec;43(6):891–902. doi: 10.1042/cs0430891. [DOI] [PubMed] [Google Scholar]
  6. 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. Gastroenterology. 1977 Apr;72(4 Pt 1):573–583. [PubMed] [Google Scholar]
  7. Elkington S. G., Floch M. H., Conn H. O. Lactulose in the treatment of chronic portal-systemic encephalopathy. A double-blind clinical trial. N Engl J Med. 1969 Aug 21;281(8):408–412. doi: 10.1056/NEJM196908212810803. [DOI] [PubMed] [Google Scholar]
  8. Elkington S. G. Lactulose. Gut. 1970 Dec;11(12):1043–1048. doi: 10.1136/gut.11.12.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fung W. P., Khoo O. T. Lactulose in the treatment of acute and chronic hepatic encephalopathy. Singapore Med J. 1971 Jun;12(3):176–180. [PubMed] [Google Scholar]
  10. Giller J., Phillips S. F. Electrolyte absorption and secretion in the human colon. Am J Dig Dis. 1972 Nov;17(11):1003–1011. doi: 10.1007/BF02239140. [DOI] [PubMed] [Google Scholar]
  11. HOFFMANN K., MOSSEL D. A., KORUS W., VAN DE KAMER J. H. UNTERSUCHUNGEN UEBER DIE WIRKUNGSWEISE DER LACTULOSE (BETA-GALACTOSIDO-FRUCTOSE) IM DARM. Klin Wochenschr. 1964 Feb 1;42:126–130. doi: 10.1007/BF01479054. [DOI] [PubMed] [Google Scholar]
  12. Lanthier P. L., Morgan M. Y. Lactitol in the treatment of chronic hepatic encephalopathy: an open comparison with lactulose. Gut. 1985 Apr;26(4):415–420. doi: 10.1136/gut.26.4.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. McNeil N. I., Cummings J. H., James W. P. Short chain fatty acid absorption by the human large intestine. Gut. 1978 Sep;19(9):819–822. doi: 10.1136/gut.19.9.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Roediger W. E., Moore A. Effect of short-chaim fatty acid on sodium absorption in isolated human colon perfused through the vascular bed. Dig Dis Sci. 1981 Feb;26(2):100–106. doi: 10.1007/BF01312224. [DOI] [PubMed] [Google Scholar]
  15. Ruppin H., Bar-Meir S., Soergel K. H., Wood C. M., Schmitt M. G., Jr Absorption of short-chain fatty acids by the colon. Gastroenterology. 1980 Jun;78(6):1500–1507. [PubMed] [Google Scholar]
  16. Summerskill W. H., Aoyagi T., Evans W. B. Ammonia in the upper gastrointestinal tract of man: quantitations and relationships. Gut. 1966 Oct;7(5):497–501. doi: 10.1136/gut.7.5.497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Vince A., Killingley M., Wrong O. M. Effect of lactulose on ammonia production in a fecal incubation system. Gastroenterology. 1978 Mar;74(3):544–549. [PubMed] [Google Scholar]
  18. Vince A., Zeegen R., Drinkwater J. E., O'Grady F., Dawson A. M. The effect of lactulose on the faecal flora of patients with hepatic encephalopathy. J Med Microbiol. 1974 May;7(2):163–168. doi: 10.1099/00222615-7-2-163. [DOI] [PubMed] [Google Scholar]
  19. Watson B. W., Meldrum S. J., Riddle H. C., Brown R. L., Sladen G. E. pH profile of gut as measured by radiotelemetry capsule. Br Med J. 1972 Apr 8;2(5805):104–106. doi: 10.1136/bmj.2.5805.104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Zeegen R., Drinkwater J. E., Fenton J. C., Vince A., Dawson A. M. Some observations on the effects of treatment with lactulose on patients with chronic hepatic encephalopathy. Q J Med. 1970 Apr;39(154):245–263. [PubMed] [Google Scholar]
  21. van Velthuijsen J. A. Food additives derived from lactose: lactitol and lactitol palmitate. J Agric Food Chem. 1979 Jul-Aug;27(4):680–686. doi: 10.1021/jf60224a040. [DOI] [PubMed] [Google Scholar]

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