Comparison of the Efficacy of Lactobacillus rhamnosus GG and Lactulose Treatments in Minimal Hepatic Encephalopathy

Abstract

Objective: Minimal hepatic encephalopathy is a condition characterized by decreased perception and consequently deterioration in quality of life, and there is still limited data on its treatment. The aim of this study is to compare the efficacy of lactulose and Lactobacillus rhamnosus GG treatments by critical flicker frequency test in minimal hepatic encephalopathy patients. Methods: Patients with a critical flicker frequency test result of <39 Hz were considered to have minimal hepatic encephalopathy. Eighty-four minimal hepatic encephalopathy patients were divided into 3 groups as lactulose, Lactobacillus rhamnosus GG, and control group. Critical flicker frequency control was performed 4 weeks after treatment. Critical flicker frequency values before and after treatment were compared according to the treatment groups and evaluated. Results: Minimal hepatic encephalopathy was detected in 84 (54.5%) of 154 cirrhosis patients. Of the patients with minimal hepatic encephalopathy, 31 (36.9%) received lactulose, 31 (36.9%) Lactobacillus rhamnosus GG treatment, and 22 (26.2%) did not receive any treatment. In patients with minimal hepatic encephalopathy compared to those without minimal hepatic encephalopathy, there were statistically significant differences in terms of age (P=.003), body mass index (BMI) (P=.019), albumin (P < .001), sodium (P = .010), model for end-stage liver diseases score (P < .001), and Child Pugh Classification (CHILD) score (P < .001).There was no significant difference between cirrhosis etiology and treatment response (P=.535). Statistically significant increase was found in critical flicker frequency values in the lactulose (P=.011) and Lactobacillus rhamnosus GG (P=.007) groups after treatment. No statistically significant difference was found in the placebo group (P=.804). There was no statistically significant difference between lactulose and Lactobacillus rhamnosus GG (P=.576). Conclusion: In the treatment of minimal hepatic encephalopathy, Lactobacillus rhamnosus GG treatment is as effective like lactulose treatment and can be used safely