Abstract
Even after the precipitant of a hepatic encephalopathy (HE) episode is treated,lactulose is often continued indefinitely. Clinical tools to predict relapse off of lactulose and guide the safe withdrawal of Rx have not been studied. Aim: Evaluate change in psychometric & MR spectroscopic(MRS)after lactulose withdrawal. Methods: Cirrhotics with prior HE underwent number connection (NCT-A/B),Block design(BDT),Digit symbol(DST)& Inhibitory control tests(ICT;lures are the outcomes) & MRS while on lactulose. Lactulose was then withdrawn. Psychometric tests were repeated 2,14& 30 days post-withdrawal. MRS was repeated 14 days post-withdrawal. Occipital gray(GM) & right parietal white matter(WM) regions were studied for glutamine(Gln), myoinositol & choline. Worsening HE leads to increase in Gln. Repeated measures analyses were used to model tests over time & determine relapse predictors. Results: 7 cirrhotics (age 53±7yrs,5 HCV,2 alcohol) on lactulose for 6±5 mths for precipitated HE(5 GI bleed, 2 infections) were included.3 patients clinically relapsed 38±6 days post-withdrawal; all 3 had >15 ICT lures while on lactulose. None of those who scored 15 ICT lures on lactulose relapsed. Gln levels in gray/white matter increased after lactulose withdrawal. Psychometric performance on therapy can predict the risk of relapse off of lactulose treatment.
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