Comparative modes of action of lactitol and lactulose in the treatment of hepatic encephalopathy.
Open accessAbstract
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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In the large intestine, lactulose is broken down by colonic bacteria primarily to lactic acid, and also to small amounts of formic and acetic acids.
“In the large intestine lactulose is broken down by the action of colonic bacteria primarily to lactic acid, and also to small amounts of formic and acetic acids [56,57].”
From Nitrate reduction to nitrite, nitric oxide and ammonia by gut bacteria under physiological conditions (2015) · cites this paper as [56]
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Tiso, M., & Schechter, A. N. (2015) · PLOS ONE · doi:10.1371/journal.pone.0119712 · Cited by 311 · see citing works
- Authors
- Patil, D. H., Westaby, D., Mahida, Y. R., Palmer, K. R., Rees, R., Clark, M. L., Dawson, A. M., & Silk, D. B.
- Affiliations
- St Bartholomew's Hospital (GB)
- ORCID
- Silk, D B
- Venue
- Gut
- Publisher
- BMJ
- Published
- 1987-03
- Volume
- 28
- Issue
- 3
- Pages
- 255-259
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1432706
- OpenAlex
- W2131557798
- Cited by
- 87
- References
- 26
- Citations by year
- 2024: 2 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 1 · 2016: 5 · 2015: 4 · 2014: 2 · 2013: 2 · 2012: 4
- FWCI
- 9.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- lactitol, lactulose, hepatic encephalopathy, colonic fermentation, fecal bacteria, volatile fatty acids, colonic pH, neomycin, radio telemetry
- MeSH terms
- Colon, Disaccharides, Fatty Acids, Volatile, Feces, Hepatic Encephalopathy, Humans, Hydrogen-Ion Concentration, Lactulose, Neomycin, Sugar Alcohols
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