Lactulose

Lactulose

Tolerance and Long-Term Efficacy of Polyethylene Glycol 4000 (Forlax(R)) Compared to Lactulose in Elderly Patients with Chronic Constipation.[Pubmed:28346570]

J Nutr Health Aging. 2017;21(4):429-439.

OBJECTIVES: To assess the tolerance and potential nutritional consequences of long-term repeated doses of PEG 4000 (10 to 30 g/day) in elderly patients with chronic constipation as compared to Lactulose (10-30 g/day). DESIGN: Single blind, randomised, multicentre, parallel group comparative study. SETTING: Community-dwelling patients and nursing homes residents aged 70 years and older with a history of chronic constipation. Treatment intervention: PEG 4000 (10-30 g/day) or Lactulose (10-30 g/day) for six months. ASSESSMENTS: Clinical nutritional status (Mini Nutritional Assessment), blood and stool samples were taken at baseline and after three and six months for assay of nutritional and absorption parameters. A patient diary documented digestive symptoms and adverse events were recorded. Information on efficacy (stool frequency and consistency) was collected as a secondary outcome measure. RESULTS: Of the 316 patients screened, 245 eligible patients constituted the ITT population (PEG 4000: N = 118; Lactulose group: N = 127). The proportion of patients receiving PEG 4000 with abnormal levels of electrolytes, nutritional markers or vitamins did not significantly change in the six months after initiating laxative treatment and do not differ between the two groups. After a D-xylose challenge test, the proportion of patients with abnormally low xylosaemia (suggesting malabsorption) varied from 24.6% at baseline to 35.8% after six months in the PEG 4000 group and from 29.1% to 42.4% in the Lactulose group, with no significant between-group or within-group differences. The proportion of patients with poor nutritional status (MNA score <17) varied from 8.5% at baseline to 9.8% after 6 months in the PEG 4000 group and from 3.9% to 5.0% in the Lactulose group. No changes in stool fat or total or soluble stool nitrogen were observed in the minority of patients for whom stool analysis was performed. A significantly higher stool frequency (p <0.05) and improved stool consistency (p <0.05) was observed in the PEG 4000 group compared to the Lactulose group at each monthly evaluation period. CONCLUSIONS: After six months of treatment with PEG 4000, no clinically relevant changes in biochemical and nutritional parameters and no unanticipated treatment-related adverse events were detected, demonstrating the good clinical tolerance of PEG 4000 in this population of elderly constipated patients. This tolerance was associated with a better clinical efficacy of PEG 4000 compared to Lactulose.

Efficient production of lactulose from whey powder by cellobiose 2-epimerase in an enzymatic membrane reactor.[Pubmed:28285222]

Bioresour Technol. 2017 Jun;233:305-312.

In this study, the gene encoding cellobiose 2-epimerase from Caldicellulosiruptor saccharolyticus (CsCE) was successfully expressed in Bacillus subtilis WB800. After the fermentation medium optimization, the activity of recombinant strain was 4.5-fold higher than the original medium in a 7.5L fermentor. The optimal catalytic pH and temperature of crude CsCE were 7.0 and 80 degrees C, respectively. An enzymatic synthesis of Lactulose was developed using cheese-whey lactose as its substrate. The maximum conversion rate of whey powder obtained was 58.5% using 7.5 U/mL CsCE. The enzymatic membrane reactor system exhibited a great operational stability, confirmed with the higher lactose conversion (42.4%) after 10 batches. To our best knowledge, this is the first report of Lactulose synthesis in food grade strain, which improve the food safety, and we not only realize the biological production of Lactulose, but also make good use of industrial waste, which have positive impact on environment.

Utility of the wireless motility capsule and lactulose breath testing in the evaluation of patients with Parkinson's disease who present with functional gastrointestinal symptoms.[Pubmed:28321329]

BMJ Open Gastroenterol. 2017 Feb 23;4(1):e000132.

BACKGROUND: The aetiology and origin of gastrointestinal symptoms in Parkinson's disease (PD) remains poorly understood. Gastroparesis, small bowel transit delay and bacterial overgrowth may, individually or collectively, play a role. AIMS: In patients with PD and functional gastrointestinal symptoms, we aimed to determine the utility of the wireless motility capsule and Lactulose breath tests in further defining their symptoms' aetiology. METHODS: In this retrospective cohort study, consecutive patients with PD and functional gastrointestinal symptoms underwent clinical assessment, as well as wireless motility capsule and Lactulose breath testing using standard protocols. RESULTS: We studied 65 patients with PD and various gastrointestinal symptoms. 35% exhibited gastroparesis by the wireless motility capsule study, 20% small bowel transit delay, while 8% had combined transit abnormalities, suggestive of overlapping gastric and small bowel dysmotility. Small bowel bacterial overgrowth was seen in 34% of cases. Symptoms of abdominal pain, regurgitation, bloating, nausea, vomiting, belching and weight loss could not distinguish between patients with or without gastroparesis, although bloating was significantly more prominent (p<0.001) overall and specifically more so in patients with slow small bowel transit (p<0.01). There was no relationship between delayed small bowel transit time and bacterial overgrowth (p=0.5); PD scores and duration were not correlated with either the transit findings or small bowel bacterial overgrowth. CONCLUSIONS: Functional gastrointestinal symptoms in patients with PD may reflect gastroparesis, small bowel transit delay or both, suggesting motor and/or autonomic dysfunction, and may be associated with small bowel bacterial overgrowth. The wireless motility capsule and Lactulose breath testing are non-invasive and useful in the assessment of these patients.

Polyethylene Glycol and Lactulose versus Lactulose Alone in the Treatment of Hepatic Encephalopathy in Patients with Cirrhosis: A Non-Inferiority Randomized Controlled Trial.[Pubmed:28316761]

Middle East J Dig Dis. 2017 Jan;9(1):12-19.

BACKGROUND In this clinical trial, polyethylene glycol (PEG) solution was compared with Lactulose in the treatment of hepatic encephalopathy in patients with cirrhosis. METHODS This randomized controlled trial was performed on 40 patients in two groups. The patients in the Lactulose group received either 20-30 grams of Lactulose orally or by a nasogastric tube, or 200 grams of Lactulose enema by a rectal tube. The patients in the PEG-Lactulose group received the same amount of oral or rectal Lactulose, plus 280 grams of PEG in 4 liters of water orally as a single dose in 30-120 minutes. Serial physical examinations, hepatic encephalopathy scoring algorithm (HESA), blood level of ammonia, and serum biochemical studies were used to evaluate the severity of hepatic encephalopathy. RESULTS In comparison with Lactulose alone, PEG-Lactulose could improve HESA score in 24 hours more effectively (p =0.04). Overall, PEG-Lactulose regimen was associated with a decrease in length of hospital stay compared with Lactulose treatment (p =0.03) but in subgroup analysis we found that PEG-Lactulose regimen could only decrease the length of hospital stay in women significantly (p =0.01). CONCLUSION The use of PEG along with Lactulose in comparison with Lactulose alone is more effective in the treatment of hepatic encephalopathy in patients with cirrhosis and results in more rapid discharge from hospital.