lactulose / Generic mfg. - LARVOL DELTA

ACUTE KIDNEY INJURY COMPLICATING ALCOHOL LIVER CIRRHOSIS WITH PORTAL HYPERTENSION, HIGH-TENSION ASCITES AND COMPARTMENT SYNDROME - IS THIS HEPATORENAL SYNDROME OR CONTRAST-INDUCED NEPHROPATHY? (ISN-WCN 2026) - "He developed post-paracentesis syndrome with acutely worsening encephalopathy that triggered the institution of oral Lactulose administration...Encephalopathy improved and by hospital day 8, he reported increasing urine output while still on PO Furosemide 80 mg BID + Spironolactone 50 mg daily...There was no evidence to support peritonitis or any sepsis. Given the subsequent improvement in kidney function, arguably, there was no element of hepatorenal syndrome.It is therefore pertinent that treating physicians must be aware that worsening acute injury complicating liver cirrhosis could represent an array of different etiologies, only one of which is hepatorenal syndrome."

Acute Kidney Injury • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Fibrosis • Gastroenterology • Heart Failure • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis • Nephrology • Portal Hypertension • Renal Disease • Septic Shock • Substance Abuse

EFFECT OF LACTULOSE ON PROTEIN-BOUND UREMIC TOXIN LOWERING IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS: A RANDOMIZED CONTROLLED TRIAL (LACTULOWERING) (ISN-WCN 2026) - "These results suggest a potential uremic toxin–lowering effect of lactulose in pre-dialysis CKD patients. Further analysis with the complete study population is warranted to confirm these findings and assess their clinical relevance."

Clinical • Cardiovascular • Chronic Kidney Disease • Constipation • Gastroenterology • Gastrointestinal Disorder • Nephrology • Renal Disease

Development of a cold-adapted enzymatic cascade system for in situ value-added conversion of milk. (PubMed, Food Chem) - "In this study, a cold-adapted enzymatic cascade was developed for in-situ lactose-to-lactulose conversion...Electronic nose/tongue analysis confirmed flavor improvement without off-notes. This low-temperature, self-inactivating system offers a sustainable route for producing premium low-lactose milk enriched with prebiotics."

Journal • Gastrointestinal Disorder • Metabolic Disorders

Directed evolution of cellobiose 2-epimerase and its application in the synthesis of lactulose (PubMed, Sheng Wu Gong Cheng Xue Bao) - "With 350 g/L lactose as the substrate, CmCE/D226G/S180T achieved a lactulose yield of 54.8% and an epilactose yield of 9.2%, while CmCE/D226G only reached a lactulose yield of 50% and an epilactose yield of 10.3%. Taken together, this work provides an elite enzyme for catalyzing the transformation of lactose to lactulose, which especially facilitates the innovation of eco-friendly synthesis of lactulose."

Journal

Prevalence and risk factors of subclinical hepatic encephalopathy in patients with cirrhosis. (PubMed, Ann Gastroenterol) - "The exclusion criteria included overt hepatic encephalopathy, recent gastrointestinal hemorrhage, neurological disease, and the use of lactulose or non-absorbable antibiotics...SHE is prevalent in patients with cirrhosis and significantly affects cognitive and psychomotor abilities. Although the study sample was small, these findings highlight the necessity of regular psychometric testing in cirrhotic patients to identify and manage SHE."

Journal • CNS Disorders • Fibrosis • Hematological Disorders • Hepatic Encephalopathy • Immunology • Liver Cirrhosis

Hyperammonemia syndrome due to Pluralibacter gergoviae bacteremia in an immunocompromised patient: case report. (PubMed, ASM Case Rep) - "Management included targeted antimicrobial therapy with ceftriaxone and meropenem, along with lactulose, rifaximin, and zinc for hyperammonemia. Ammonia levels and mental status gradually normalized following treatment, and blood cultures cleared. This case illustrates P. gergoviae as an emerging opportunistic pathogen capable of causing invasive infection and possibly metabolic complications in profoundly immunocompromised hosts."

Journal • CNS Disorders • Cystic Fibrosis • Genetic Disorders • Hepatology • Immunology • Infectious Disease • Liver Failure • Pulmonary Disease • Respiratory Diseases • Transplantation

Effect Of Polyethylene Glycol Versus Lactulose on Hepatic Encephalopathy In Patients With Liver Cirrhosis: A Randomized Clinical Trial (PEG-HE Trial) (APASL 2026) - No abstract available

Clinical • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis

DCP-PCT-EPI: Breath Test-Based Assessment of SIBO in Chronic Pancreatitis and Partial Pancreatectomy (clinicaltrials.gov) - P=N/A | N=100 | Not yet recruiting | Sponsor: Fondazione Policlinico Universitario Agostino Gemelli IRCCS

New trial • Pancreatitis

Use and effectiveness of lactulose and rifaximin in patients with cirrhosis and hepatic encephalopathy highlight need for new treatments: insights from real-world data (EASL 2026) - No abstract available

Clinical • Real-world • Real-world evidence • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology

Effect of polyethylene glycol versus lactulose on hepatic encephalopathy in patients with liver cirrhosis: a randomized clinical trial (PEG-HE trial) (EASL 2026) - No abstract available

Clinical • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis

Persistent Hyperammonemia Revealing FARS2 Deficiency in Adult Super-Refractory Status Epilepticus (SCCM 2026) - "This report expands the known clinical phenotype and highlights the importance of early metabolic evaluation in unexplained status epilepticus.Description: A 25-year-old female with polycystic ovarian syndrome presented with new onset seizures initially treated with levetiracetam and was discharged with neurology follow-up...Status epilepticus persisted despite therapy requiring over 30 days in a medically induced coma.Her ICU course was further complicated by persistent hyperammonemia with elevated liver enzymes, unresponsive to lactulose, rifaximin and levocarnitine...This presentation should prompt consideration for rare metabolic disorder such as FARS 2 deficiency. Recognizing this early enables targeted nutritional therapy and prevents prolonged futile escalation of antiepileptic drugs."

Clinical • CNS Disorders • Developmental Disorders • Epilepsy • Metabolic Disorders • Movement Disorders • Polycystic Ovary Syndrome

Enteral Fructo-Oligosaccharide Preserves Gut Integrity and Microbial Diversity in Pediatric ARDS (SCCM 2026) - "Urine Lactulose/Mannitol Ratios were lower for patients with EN+FOS, p=0.02, indicating a less permeable intestinal epithelium... Although limited by small sample size, this subgroup analysis suggests that FOS supplementation of EEN may preserve gut microbiome diversity and improve intestinal barrier integrity in PARDS. Further study is needed to determine if FOS supplementation can act via butyrate signaling to improve lung inflammation, and ultimately, improve PARDS outcomes."

Clinical • Acute Respiratory Distress Syndrome • Inflammation • Pediatrics • Pneumonia • Respiratory Diseases • IL6 • TNFA

A RARE DETOUR: UNMASKING A PORTOSYSTEMIC SHUNT IN REFRACTORY HEART FAILURE AND PULMONARY HYPERTENSION (ACC 2026) - "This collaborative approach was essential to differentiate the shunt's contribution from underlying cardiac and hepatic pathology, guide intervention timing, and optimize management with lactulose and rifaximin alongside heart failure therapy. This extraordinarily rare shunt type highlights the importance of considering extracardiac contributors in refractory HF with unexplained encephalopathy. Early multidisciplinary involvement is crucial for unraveling complex cases where multisystem pathologies intersect."

Atrial Fibrillation • Cardiovascular • CNS Disorders • Congestive Heart Failure • Fibrosis • Heart Failure • Hepatology • Immunology • Portal Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

The PEARL trial: Prevention of hepatic Encephalopathy by administration of Rifaximin and Lactulose in patients with liver cirrhosis undergoing placement of a transjugular intrahepatic portosystemic shunt: a multi-centre randomized, double blind, placebo controlled trial. (clinicaltrialsregister.eu) - P4 | N=91 | Recruiting | Sponsor: Amsterdam UMC Stichting | Not yet recruiting ➔ Recruiting

Enrollment open • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis

Hepatitis C-related cirrhosis : Predictive Factors of Hepatic Recompensation After Sustained Virologic Response. (BWG 2026) - "Hepatic recompensation was defined according to the Baveno VII consensus (2022) as the fulfilment of all the following criteria:(a) cure or suppression of the primary aetiology (HCV elimination), (b) resolution of ascites (off diuretics), hepatic encephalopathy (off lactulose/rifaximin), and absence of recurrent variceal bleeding for at least 12 months, and (c) stable improvement in liver function (albumin, INR, bilirubin). Hepatic recompensation after SVR was achieved in 40.4% of cases. Baseline viral load was the main independent predictive factor of this favourable outcome. These results highlight the importance of early management of cirrhotic patients to optimize their chances of recompensation."

Biomarker • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatitis C • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Cirrhosis • Metabolic Disorders • Solid Tumor

Evaluation of the Outcome of Fecal Microbiota Transplantation (clinicaltrials.gov) - P1/2 | N=40 | Not yet recruiting | Sponsor: Air Force Military Medical University, China

New P1/2 trial • CNS Disorders • Hepatic Encephalopathy • Transplantation

Relationship Between Diet Quality, Intestinal Permeability, and Gut Microbiota Features in Individuals with Obesity. (PubMed, Nutrients) - " Higher dietary pattern scores correlated with lower levels of intestinal permeability measures such as 24 h urinary sucralose (HEI-2010: r = -0.33, p = 0.002; MDP: r = -0.31, p = 0.004; DASH: r = -0.38, p < 0.0001) and 24 h sucralose-to-lactulose ratio (HEI-2010: r = -0.23, p = 0.03; MDP: r = -0.32, p = 0.003; DASH: r = -0.24, p = 0.03)...Higher DASH scores correlated with lower Proteobacteria (r = -0.28, p = 0.004) and higher Verrucomicrobia (r = 0.30, p = 0.002) phylum abundance. The current results suggest a potential role for diet quality in promoting intestinal health."

Journal • Cardiovascular • Genetic Disorders • Hypertension • Obesity

Standardizing Intestinal Permeability Assessment: Optimization of Gluten Dose and Urine Collection Times for u-GIP and Lactulose:Mannitol Ratio in Healthy Volunteers. (PubMed, Int J Mol Sci) - "A 4 g gluten challenge combined with a 6 h urine collection demonstrated effectiveness in healthy volunteers and may be suitable for clinical application. Further research involving larger cohorts of both healthy individuals and patients with intestinal hyperpermeability is required to validate this method."

Biomarker • Journal

Small Intestinal Bacterial Overgrowth and Intestinal Methanogen Overgrowth: Are They Overdiagnosed? (PubMed, Acta Gastroenterol Latinoam) - "However, a critical review of recent literature suggests that reliance on breath tests, particularly those using lactulose as the substrate, has led to overdiagnosis of small intestinal bacterial overgrowth...We advocate a critical and cautious approach to the diagnosis of small intestinal bacterial overgrowth and intestinal methanogen overgrowth, and that antibiotics are prescribed are with great care. We also look forward to the application of modern molecular microbiology to the study of the small intestinal microbiome and metabolome, including a more complete understanding of methane biology."

Journal • Review • Gastrointestinal Disorder

A metabolomics approach to fingerprint the heat-induced alterations in milk and identify potential thermal biomarkers. (PubMed, Food Res Int) - "The findings fingerprint the thermal-induced biochemical changes in milk, and Lactulose as a potential thermal biomarker for milk quality and authenticity. Further research is required to assess the practical feasibility of the biomarker and the practices needed to optimize dairy processing techniques."

Biomarker • Journal • Metabolic Disorders

Diabetic ketoacidosis as the initial presentation of hepatogenous diabetes: a first reported case. (PubMed, Endocrinol Diabetes Metab Case Rep) - "The patient was managed with insulin and lactulose, resulting in clinical improvement...HbA1C is an unreliable marker for diagnosing diabetes in cirrhotic patients due to shortened red blood cell lifespan; OGTT should be considered when hepatogenous diabetes is suspected despite normal glycemic markers. Subclinical infections can precipitate DKA in cirrhosis through stress-induced insulin resistance."

Journal • Diabetes • Fibrosis • Gastroenterology • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis • Metabolic Disorders

Difficulties in diagnosing a pediatric patient with small intestinal bacterial overgrowth. (PubMed, Einstein (Sao Paulo)) - "The diagnosis was confirmed via a hydrogen breath test with lactulose, supported by radiological findings. Following treatment with metronidazole (30 mg/kg/day for 10 days), the patient demonstrated significant clinical resolution of the previously reported symptoms. A follow-up hydrogen breath test revealed no further evidence of bacterial overgrowth in the small intestine."

Journal • Celiac Disease • Constipation • Critical care • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Metabolic Disorders • Pain • Pediatrics

ERAS-based sequential olive oil-lactulose protocol in day-case laparoscopic inguinal hernia repair: a prospective comparison. (PubMed, Front Surg) - "Within the ERAS pathway, the sequential approach of olive oil and lactulose significantly improved bowel preparation compliance and tolerance in patients undergoing daytime laparoscopic inguinal hernia repair. This approach accelerated gastrointestinal function recovery, shortened hospital stays, reduced complication rates, alleviated postoperative pain, and enhanced patient satisfaction."

Journal • Gastroenterology • Pain • Xerostomia

(BLOOM): Lactulose to Improve Gut Health in Cancer Patients Receiving Immunotherapy (clinicaltrials.gov) - P1/2 | N=55 | Not yet recruiting | Sponsor: University of Chicago | Initiation date: Jan 2026 ➔ Dec 2026

Trial initiation date • B Cell Lymphoma • Classical Hodgkin Lymphoma • Esophageal Cancer • Head and Neck Cancer • Hepatocellular Cancer • Lung Cancer • Mucosal Melanoma • Non Small Cell Lung Cancer • Oncology • Renal Cell Carcinoma • Squamous Cell Carcinoma of Head and Neck • TMB

A Case of Hyperammonemia Induced by 5‒FU in a Patient with Advanced Rectal Cancer (PubMed, Gan To Kagaku Ryoho) - "After sigmoid colostomy, FOLFOXIRI plus bevacizumab as preoperative chemotherapy was initiated. On day 3, during continuous administration of 5‒fluorouracil(5‒FU), the patient developed impaired consciousness accompanied by convulsive seizures and conjugate deviation...Administration of lactulose was started...The patient was discharged home without complication on postoperative day 13. We report this case of advanced rectal cancer in which administration of high‒dose 5‒FU caused hyperammonemia accompanied by impaired consciousness, with a literature review."

Journal • CNS Disorders • Colorectal Cancer • Epilepsy • Hepatology • Oncology • Rectal Cancer • Solid Tumor