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Shiv Kumar Sarin - One of the best experts on this subject based on the ideXlab platform.
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a randomized double blind controlled trial comparing rifaximin plus Lactulose with Lactulose alone in treatment of overt hepatic encephalopathy
The American Journal of Gastroenterology, 2013Co-Authors: Barjesh Chander Sharma, Praveen Sharma, Manish Kumar Lunia, Siddharth Srivastava, Rohit Goyal, Shiv Kumar SarinAbstract:A Randomized, Double-Blind, Controlled Trial Comparing Rifaximin Plus Lactulose With Lactulose Alone in Treatment of Overt Hepatic Encephalopathy
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primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis an open labeled randomized controlled trial of Lactulose versus no Lactulose
Journal of Gastroenterology and Hepatology, 2012Co-Authors: Praveen Sharma, Barjesh Chander Sharma, Amit Agrawal, Shiv Kumar SarinAbstract:Background and Aim: Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE. There is no study on the prevention of overt HE using Lactulose in patients who never had HE earlier. Methods: Consecutive cirrhotic patients who never had an episode of overt HE were randomized to receive Lactulose (Gp-L) or no Lactulose (Gp-NL). All patients were assessed by psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency test (CFF) at inclusion and after 3 months. These patients were followed every month for 12 months for development of overt HE. Results: Of 250 patients screened, 120 (48%) meeting the inclusion criteria were randomized to Gp-L (n = 60) and Gp-NL (n = 60). Twenty (19%) of 105 patients followed for 12 months developed an episode of overt HE. Six (11%) of 55 in the Lactulose (Gp-L) group and 14 (28%) of 50 in the Gp-NL (P = 0.02) developed overt HE. Ten (20%) of 50 patients in Gp-NL and five (9%) of 55 patients in the Gp-L group died, P = 0.16. Number of patients with minimal hepatic encephalopathy (MHE) were comparable in two groups at baseline (Gp-L vs Gp-NL, 32:36, P = 0.29). Lactulose improved MHE in 66% of patients in Gp-L. Taking a cutoff < 38 Hz sensitivity and specificity of CFF in predicting HE were 52% and 77% at baseline and 52% and 82% at 3 months of treatment. On multivariate analysis, Child's score and presence of MHE at baseline were significantly associated with development of overt HE. Conclusions: Lactulose is effective for primary prevention of overt hepatic encephalopathy in patients with cirrhosis.
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an open label randomized controlled trial of Lactulose and probiotics in the treatment of minimal hepatic encephalopathy
European Journal of Gastroenterology & Hepatology, 2008Co-Authors: Praveen Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:Background and aimMinimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with Lactulose and probiotics has shown some benefit. We compared Lactulose with probiotics and a combination of Lactulose plus probiotics in the treatment of MHE.P
Praveen Sharma - One of the best experts on this subject based on the ideXlab platform.
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a randomized double blind controlled trial comparing rifaximin plus Lactulose with Lactulose alone in treatment of overt hepatic encephalopathy
The American Journal of Gastroenterology, 2013Co-Authors: Barjesh Chander Sharma, Praveen Sharma, Manish Kumar Lunia, Siddharth Srivastava, Rohit Goyal, Shiv Kumar SarinAbstract:A Randomized, Double-Blind, Controlled Trial Comparing Rifaximin Plus Lactulose With Lactulose Alone in Treatment of Overt Hepatic Encephalopathy
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primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis an open labeled randomized controlled trial of Lactulose versus no Lactulose
Journal of Gastroenterology and Hepatology, 2012Co-Authors: Praveen Sharma, Barjesh Chander Sharma, Amit Agrawal, Shiv Kumar SarinAbstract:Background and Aim: Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE. There is no study on the prevention of overt HE using Lactulose in patients who never had HE earlier. Methods: Consecutive cirrhotic patients who never had an episode of overt HE were randomized to receive Lactulose (Gp-L) or no Lactulose (Gp-NL). All patients were assessed by psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency test (CFF) at inclusion and after 3 months. These patients were followed every month for 12 months for development of overt HE. Results: Of 250 patients screened, 120 (48%) meeting the inclusion criteria were randomized to Gp-L (n = 60) and Gp-NL (n = 60). Twenty (19%) of 105 patients followed for 12 months developed an episode of overt HE. Six (11%) of 55 in the Lactulose (Gp-L) group and 14 (28%) of 50 in the Gp-NL (P = 0.02) developed overt HE. Ten (20%) of 50 patients in Gp-NL and five (9%) of 55 patients in the Gp-L group died, P = 0.16. Number of patients with minimal hepatic encephalopathy (MHE) were comparable in two groups at baseline (Gp-L vs Gp-NL, 32:36, P = 0.29). Lactulose improved MHE in 66% of patients in Gp-L. Taking a cutoff < 38 Hz sensitivity and specificity of CFF in predicting HE were 52% and 77% at baseline and 52% and 82% at 3 months of treatment. On multivariate analysis, Child's score and presence of MHE at baseline were significantly associated with development of overt HE. Conclusions: Lactulose is effective for primary prevention of overt hepatic encephalopathy in patients with cirrhosis.
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an open label randomized controlled trial of Lactulose and probiotics in the treatment of minimal hepatic encephalopathy
European Journal of Gastroenterology & Hepatology, 2008Co-Authors: Praveen Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:Background and aimMinimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with Lactulose and probiotics has shown some benefit. We compared Lactulose with probiotics and a combination of Lactulose plus probiotics in the treatment of MHE.P
Barjesh Chander Sharma - One of the best experts on this subject based on the ideXlab platform.
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a randomized double blind controlled trial comparing rifaximin plus Lactulose with Lactulose alone in treatment of overt hepatic encephalopathy
The American Journal of Gastroenterology, 2013Co-Authors: Barjesh Chander Sharma, Praveen Sharma, Manish Kumar Lunia, Siddharth Srivastava, Rohit Goyal, Shiv Kumar SarinAbstract:A Randomized, Double-Blind, Controlled Trial Comparing Rifaximin Plus Lactulose With Lactulose Alone in Treatment of Overt Hepatic Encephalopathy
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primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis an open labeled randomized controlled trial of Lactulose versus no Lactulose
Journal of Gastroenterology and Hepatology, 2012Co-Authors: Praveen Sharma, Barjesh Chander Sharma, Amit Agrawal, Shiv Kumar SarinAbstract:Background and Aim: Development of overt hepatic encephalopathy (HE) is associated with poor prognosis in patients with cirrhosis. Lactulose is used for the treatment of HE. There is no study on the prevention of overt HE using Lactulose in patients who never had HE earlier. Methods: Consecutive cirrhotic patients who never had an episode of overt HE were randomized to receive Lactulose (Gp-L) or no Lactulose (Gp-NL). All patients were assessed by psychometry (number connection test [NCT-A and B], figure connection test if illiterate [FCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency test (CFF) at inclusion and after 3 months. These patients were followed every month for 12 months for development of overt HE. Results: Of 250 patients screened, 120 (48%) meeting the inclusion criteria were randomized to Gp-L (n = 60) and Gp-NL (n = 60). Twenty (19%) of 105 patients followed for 12 months developed an episode of overt HE. Six (11%) of 55 in the Lactulose (Gp-L) group and 14 (28%) of 50 in the Gp-NL (P = 0.02) developed overt HE. Ten (20%) of 50 patients in Gp-NL and five (9%) of 55 patients in the Gp-L group died, P = 0.16. Number of patients with minimal hepatic encephalopathy (MHE) were comparable in two groups at baseline (Gp-L vs Gp-NL, 32:36, P = 0.29). Lactulose improved MHE in 66% of patients in Gp-L. Taking a cutoff < 38 Hz sensitivity and specificity of CFF in predicting HE were 52% and 77% at baseline and 52% and 82% at 3 months of treatment. On multivariate analysis, Child's score and presence of MHE at baseline were significantly associated with development of overt HE. Conclusions: Lactulose is effective for primary prevention of overt hepatic encephalopathy in patients with cirrhosis.
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Lactulose for minimal hepatic encephalopathy in patients with extrahepatic portal vein obstruction
Saudi Journal of Gastroenterology, 2012Co-Authors: P Sharma, Barjesh Chander SharmaAbstract:Background/Aims: Minimal hepatic encephalopathy (MHE) is common in patients with extrahepatic portal vein obstruction (EHPVO). There is no study on the treatment of MHE using Lactulose in patients with EHPVO. Patients and Methods: Consecutive EHPVO patients were assessed by psychometric (number connection test (NCT-A and B), digit symbol test (DST), serial dot test (SDT), line tracing test (LTT)), and critical flicker frequency (CFF) at inclusion. Patients diagnosed as MHE were treated with Lactulose and psychometric tests, CFF, and were reassessed after 3 months. Results: Of the 70 patients screened, the prevalence of abnormal psychometric test was as follows: NCT-A (41%), NCT-B (53%), DST (38%), SDT (40%), and LTT (44%). Thirty patients (43%) had two or more than two abnormal (>2 SD) psychometry tests. Lactulose improved MHE in 16/30 (53%) of patients after 3 months of treatment. Arterial ammonia decreased after Lactulose treatment compared to baseline (83.7±19.1 vs. 65.1±19.3 μmol/l, P=0.001). A total of 9 (75%) of 12 patients with large spontaneous shunt and 7 (39%) of 18 patients without spontaneous shunt improved with Lactulose (P=0.07). CFF in patients with MHE (n=30) was significantly lower than those without MHE (n=40) (38.1±2.4 vs. 41.5±3.1 Hz, P=0.01). CFF was less than 38 Hz in 21 (70%) of 30 patients before treatment and in 10 (33%) patients after Lactulose therapy in MHE patients. All patients could tolerate Lactulose without any significant side effects. Four patients (13%) developed transient diarrhea in whom dose needed reduction, 3 (10%) did not like its taste but have continued, and 2 (6%) developed abdominal bloating sensation. Conclusions: Lactulose is effective in the treatment of MHE in patients with EHPVO.
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an open label randomized controlled trial of Lactulose and probiotics in the treatment of minimal hepatic encephalopathy
European Journal of Gastroenterology & Hepatology, 2008Co-Authors: Praveen Sharma, Barjesh Chander Sharma, Vinod Puri, Shiv Kumar SarinAbstract:Background and aimMinimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with Lactulose and probiotics has shown some benefit. We compared Lactulose with probiotics and a combination of Lactulose plus probiotics in the treatment of MHE.P
Lutz Fischer - One of the best experts on this subject based on the ideXlab platform.
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enzymatic production and complete nuclear magnetic resonance assignment of the sugar Lactulose
Journal of Agricultural and Food Chemistry, 2004Co-Authors: Jurgen Mayer, Jurgen Conrad, Iris Klaiber, Sabine Lutzwahl, Uwe Beifuss, Lutz FischerAbstract:The enzymatic transgalactosylation from lactose to fructose leading to the prebiotic disaccharide Lactulose was investigated using the β-galactosidase from Aspergillus oryzae and the hyperthermostable β-glycosidase from Pyrococcus furiosus (CelB). The conditions for highest Lactulose yields relative to the initial lactose concentration were established on a 1 mL scale. Dependent on the initial molar ratio of lactose to fructose, more or fewer oligosaccharides other than Lactulose were generated. Bioconversions on a 30 mL scale in a stirred glass reactor were performed, and Lactulose yields of 46 mmol/L (44% relative to lactose) for CelB and 30 mmol/L (30% relative to lactose) for A. oryzae β-galactosidase were achieved. Only <5% of other oligosaccharides were detectable. The corresponding productivities were 24 and 16 mmol/L/h, respectively. The molecular structure of Lactulose was investigated in detail and confirmed after purification of the reaction solution by LC-MS and 1D and 2D NMR. Lactulose (4-O-β...
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enzymatic production and complete nuclear magnetic resonance assignment of the sugar Lactulose
Journal of Agricultural and Food Chemistry, 2004Co-Authors: Jurgen Mayer, Jurgen Conrad, Iris Klaiber, Sabine Lutzwahl, Uwe Beifuss, Lutz FischerAbstract:The enzymatic transgalactosylation from lactose to fructose leading to the prebiotic disaccharide Lactulose was investigated using the beta-galactosidase from Aspergillus oryzae and the hyperthermostable beta-glycosidase from Pyrococcus furiosus (CelB). The conditions for highest Lactulose yields relative to the initial lactose concentration were established on a 1 mL scale. Dependent on the initial molar ratio of lactose to fructose, more or fewer oligosaccharides other than Lactulose were generated. Bioconversions on a 30 mL scale in a stirred glass reactor were performed, and Lactulose yields of 46 mmol/L (44% relative to lactose) for CelB and 30 mmol/L (30% relative to lactose) for A. oryzae beta-galactosidase were achieved. Only <5% of other oligosaccharides were detectable. The corresponding productivities were 24 and 16 mmol/L/h, respectively. The molecular structure of Lactulose was investigated in detail and confirmed after purification of the reaction solution by LC-MS and 1D and 2D NMR. Lactulose (4-O-beta-D-galactopyranosyl-D-fructose) was unambiguously proved to be the major transglycosylation disaccharide.
Mervyn C. Thomas - One of the best experts on this subject based on the ideXlab platform.
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the Lactulose breath hydrogen test and small intestinal bacterial overgrowth
The American Journal of Gastroenterology, 1996Co-Authors: Stephen M. Riordan, Christopher J. Mciver, Terry D. Bolin, V M Duncombe, B M Walker, Mervyn C. ThomasAbstract:Objectives : To i) document the sensitivity and specificity of a combined scintigraphic/Lactulose breath hydrogen test for small intestinal bacterial overgrowth and ii) investigate the validity of currently accepted definitions of an abnormal Lactulose breath hydrogen test based on double peaks in breath hydrogen concentrations. Methods : Twenty-eight subjects were investigated with culture of proximal small intestinal aspirate and a 10-g Lactulose breath hydrogen test combined with scintigraphy. Gastroduodenal pH, the presence or absence of gastric bacterial overgrowth, and the in vitro capability of overgrowth flora to ferment Lactulose were determined. Results : Sensitivity (16.7%) and specificity (70.0%) of the Lactulose breath hydrogen test alone for small intestinal bacterial overgrowth were poor. Combination with scintigraphy resulted in 100% specificity, because double peaks in serial breath hydrogen concentrations may occur as a result of Lactulose fermentation by cecal bacteria. Sensitivity increased to 38.9% with scintigraphy, because a single rise in breath hydrogen concentrations, commencing before the test meal reaches the cecum, may occur in this disorder. Sensitivity remained suboptimal irrespective of the definition of small intestinal bacterial overgrowth used, the nature of the overgrowth flora, favorable luminal pH, the presence of concurrent gastric bacterial overgrowth, or the in vitro ability of the overgrowth flora to ferment Lactulose. Conclusions: Definitions of an abnormal Lactulose breath hydrogen test based on the occurrence of double peaks in breath hydrogen concentrations are inappropriate. Not even the addition of scintigraphy renders this test a clinically useful alternative to culture of aspirate for diagnosing small intestinal bacterial overgrowth.
