Abstract
Nonabsorbable disaccharides have been the mainstay of treatment for hepatic encephalopathy since introduced into clinical practice in 1966. Their beneficial effects reflect their ability to reduce the intestinal production/absorption of ammonia. A recent Cochrane review confirmed the efficacy and safety of nonabsorbable disaccharides for the treatment and prevention of hepatic encephalopathy in patients with cirrhosis. The findings were robust and support the use of nonabsorbable disaccharides as a first line treatment for hepatic encephalopathy, in this patient population, and for its prevention.
Highlights
Nonabsorbable disaccharides have been the mainstay of treatment for hepatic encephalopathy since introduced into clinical practice in 1966
They are not processed or absorbed in the small intestine but pass unchanged into the large intestine. There they are extensively metabolized by colonic bacteria to their constituent monosaccharides and to volatile fatty acids and hydrogen. Their beneficial effects reflect their ability to reduce the intestinal production/absorption of ammonia, which is achieved in four ways: (i) A laxative effect: the colonic metabolism of the nonabsorbable disaccharides results in an increase in intraluminal gas formation, an increase in intraluminal osmolality, a reduction in intraluminal pH, and an overall decrease in transit time; (ii) Bacterial uptake of ammonia: the intraluminal changes in pH result in a leaching of ammonia from the circulation into the colon
Of 38 randomized clinical trials involving 1828 participants were included and the analyses provided moderate quality evidence that use of non-absorbable disaccharides is associated with beneficial effects on hepatic encephalopathy, mortality, and serious adverse events when used to treat overt hepatic encephalopathy, minimal hepatic encephalopathy and to prevent hepatic encephalopathy
Summary
Current state of knowledge of hepatic encephalopathy (part III): non-absorbable disaccharides. This article is published with open access at Springerlink.com
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