lactulose / Generic mfg. - LARVOL DELTA

Targeting gut microbiota in liver disease: A pharmacological approach for hepatic encephalopathy and beyond. (PubMed, World J Gastrointest Pharmacol Ther) - "This review explored the latest therapeutic strategies aimed at modulating gut microbiota in liver disease, focusing on traditional approaches such as non-absorbable disaccharides (lactulose, lactitol), antibiotics (rifaximin), and probiotics as well as novel interventions, including postbiotics, synbiotics, and fecal microbiota transplantation. We also discussed the implications of gut microbiota modulation in conditions beyond HE, such as metabolic dysfunction-associated steatotic liver disease and cirrhosis. By integrating gut microbiota-targeted therapies into liver disease management, we may develop more effective, personalized approaches to improve patient outcomes and reduce complications."

Journal • Review • CNS Disorders • Cognitive Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Inflammation • Liver Cirrhosis • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Transplantation

Ten-Year Atherosclerotic Cardiovascular Disease Risk in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Separate Analyses from Romanian and Italian Cohorts Integrating Metabolic, Hepatic, and Gut-Liver Axis Markers. (PubMed, J Clin Med) - " We conducted a prospective, observational study in two tertiary centers (in Romania and Italy) and compared the outcomes with different tests available for fibrosis (FibroTest in Romania or acoustic radiation force impulse (ARFI) elastography in Italy) and intestinal permeability (IP) (by fecal zonulin in Romania or lactulose/mannitol ratio in Italy)...Neither liver fibrosis nor intestinal permeability contributed additional prognostic value in this setting, regardless of the assessment method. These data support prioritizing aggressive metabolic risk management and call for harmonized, longitudinal studies to clarify gut-liver contributions to cardiovascular outcomes."

Journal • Atherosclerosis • Cardiovascular • Diabetes • Fibrosis • Hepatology • Hypertension • Immunology • Liver Cirrhosis • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease

THEUDCA: UDCA to Prevent Post-TIPS Hepatic Encephalopathy (clinicaltrials.gov) - P=N/A | N=270 | Not yet recruiting | Sponsor: West China Hospital

New trial • CNS Disorders • Hepatic Encephalopathy

Lactulose, a Disaccharide Prebiotic, Improves the Gut-Kidney Axis via Enhancement of Akkermansia Muciniphila Production. (PubMed, Kidney360) - "Our findings suggest that lactulose functions as an in vivo AKK inducer, exerting renoprotective effects by improving intestinal barrier function in CKD. These results highlight the potential of lactulose as a prebiotic therapeutic agent for CKD management."

Journal • Constipation • Gastroenterology • Gastrointestinal Disorder • Renal Disease

Patterns of laxative use for chronic functional constipation in Japanese children: A longitudinal descriptive study. (PubMed, Pediatr Int) - "Magnesium oxide remains the most frequently prescribed laxative for pediatric CFC in Japan, with PEG 4000 now ranking second. The introduction of PEG 4000 in 2019 reduced reliance on other conventional laxatives. These findings may help clinicians tailor pharmacotherapy for childhood constipation."

Journal • Constipation • Gastroenterology • Gastrointestinal Disorder • Pediatrics

High-Throughput Screening Using the Self-Controlled Tree-Based Scan Statistic to Identify Medications Associated With Hospitalization for Severe Acute Liver Injury. (PubMed, Pharmacoepidemiol Drug Saf) - "High-throughput screening using tree-based scan statistics detected potentially hepatotoxic drugs for investigation in future pharmacoepidemiology studies."

Journal • CNS Disorders • Gastroenterology • Hepatology • Liver Failure • Pain

Intestinal methanogen overgrowth and its impact on gastrointestinal disorders in children: a retrospective study. (PubMed, BMC Gastroenterol) - "IMO positivity is prevalent in children with gastrointestinal symptoms, particularly prominent among those with FGID. The IMO positive group exhibited a lower incidence of diarrhea and more frequently demonstrated terminal ileal villous blunting. In FGID patients, IMO positivity correlates with age, showing higher rates in school-aged children."

Journal • Retrospective data • Gastroenterology • Gastrointestinal Disorder • Pediatrics

Balancing α6/α6 barrel kinetic stability and loop flexibility in a thermophilic cellobiose 2-epimerase enhanced lower temperature lactulose biosynthesis. (PubMed, Int J Biol Macromol) - "The significant biotransformation at 60 °C and 50 °C was a great achievement as undetectable biotransformation was obtained at the same temperatures with wild type CsCE. These results demonstrate how balancing stability and flexibility can be an effective strategy for improving CsCE's activity at lower than 75 °C, enabling more economical lactulose production."

Journal

Quantifying treatment value under IRA: a case study of rifaximin for the treatment of overt hepatic encephalopathy using QALY and non-QALY measures. (PubMed, J Med Econ) - "A cost-effectiveness analysis evaluated the economic value of rifaximin ± lactulose versus standard of care ± lactulose in preventing recurrent OHE in adults over a lifetime horizon from US payer and societal perspectives. After incorporating societal costs, ICERs improved to $43,908/QALY, $41,992/HYT, $49,259/evLYG, and $43,332/GRA-QALY. Rifaximin is a cost-effective treatment for preventing OHE recurrence in adults using QALY and non-QALY health benefit measures."

HEOR • Journal • CNS Disorders • Hepatic Encephalopathy • Transplantation

Effect of Different Prebiotic Saccharides on Listeria monocytogenes Adherence to Human Adenocarcinoma Caco-2 Cell Line. (PubMed, Curr Issues Mol Biol) - "The aim of this work was to determine the effect of prebiotics beta-(1,3)-D-glucan, inulin, fructooligosaccharides, galactooligosaccharides, lactulose, raffinose, stachyose, human milk oligosaccharides (HMOs), and 2'-fucosyllactose on the ability of LM to adhere to the human adenocarcinoma Caco-2 cell line...In contrast, the remaining tested prebiotics did not show a significant impact on LM adhesion. These findings highlight the potential of specific prebiotics, especially beta-glucans, to limit LM adherence, suggesting a protective effect for the host."

Journal • Preclinical • Oncology

En kvinne i 40-årene med fallende bevissthetsnivå etter oppstart av sondeernæring. (PubMed, Tidsskr Nor Laegeforen) - "She was intubated and transferred to the ICU for treatment with dialysis, sodium benzoate, lactulose and rifaximin. In this case, increased ammonia production resulted from high protein intake and muscle breakdown, while reduced elimination was due to secondary urea cycle impairment caused by post-surgery undernutrition. Clinicians should consider screening for hyperammonaemia in critically ill patients with new-onset encephalopathy, seizures or refractory vomiting despite normal liver function tests."

Journal • CNS Disorders • Epilepsy • Fatigue • Hepatology • Liver Failure • Metabolic Disorders

Factors influencing and enhancing health-related quality of life in sarcopenia patients with liver cirrhosis: A comprehensive review. (PubMed, J Family Med Prim Care) - "On the other hand, interventions such as increased physical activity, liver transplantation, stem cell therapy, mindfulness practices, and the use of probiotics, rifaximin, and lactulose showed positive effects on HRQoL. These insights underscore the importance of adopting a comprehensive management approach for liver cirrhosis that addresses not only physical health but also psychological and social well-being. Future research should aim at developing targeted interventions to reduce the burden of these risk factors and promote overall quality of life in this patient population."

HEOR • Journal • Review • CNS Disorders • Depression • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Mood Disorders • Psychiatry • Sarcopenia • Sleep Disorder • Transplantation

Gut microbiome and its metabolites in liver cirrhosis: mechanisms and clinical implications. (PubMed, Front Cell Infect Microbiol) - "Microbiome-targeted interventions-including lactulose, rifaximin, probiotics or synbiotics, fecal microbiota transplantation, and bile acid modulators-restore community balance in 70-85% of clinical trials, although efficacy and safety vary by etiology and baseline microbiota composition. Integrated microbiome-metabolome models achieve areas under the curve (AUCs) of 0.82-0.90 for noninvasive classification and early detection of cirrhosis. Collectively, these findings underscore reproducible, quantitative microbiome-metabolite alterations and outline a roadmap for microbiome-informed precision care that connects mechanistic insight with clinical application, emphasizing the need for longitudinal and multi-ethnic validation."

Journal • Review • Cardiovascular • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Hypertension • Immunology • Inflammation • Liver Cirrhosis • Portal Hypertension • Transplantation

Structural characterization of fructans from Polygonatum kingianum and their effects on LOP-induced constipation in mice. (PubMed, Carbohydr Polym) - "Pharmacological evaluation in a loperamide-induced murine constipation model demonstrated that PKF administration significantly alleviated constipation symptoms. Notably, PKF elicited comparable or superior therapeutic effects to the positive control lactulose (2.5 g/kg) at significantly lower doses (100-400 mg/kg). These findings establish a theoretical foundation for the potential applications of low molecular weight carbohydrate compounds derived from P. kingianum."

Journal • Preclinical • Constipation • Gastroenterology • Gastrointestinal Disorder • KIT

Hyperammonemia and Encephalopathy in Ureterosigmoidostomy: A Nephrology Challenge Beyond the Liver (KIDNEY WEEK 2025) - "He was initiated on Lactulose, rifaximin, bicarbonate and fluid repletion...Broad-spectrum antibiotics with piperacillin-tazobactam and doxycycline were initiated for gut bacterial suppression, resulting in clinical improvement and resolution of HA...Additionally, patients with USS lack a urinary route for NH3 excretion, predisposing them to HA and metabolic encephalopathy. This case highlights the need for awareness of this unique presentation; urinary diversion is necessary"

Bladder Cancer • Chronic Kidney Disease • CNS Disorders • Fibrosis • Genito-urinary Cancer • Hepatology • Immunology • Liver Failure • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Nephrology • Prostate Cancer • Solid Tumor • Urology

Ureaplasma-Induced Hyperammonemia Syndrome - an Acute Complication Post Allogeneic Stem Cell Transplant (ASH 2023) - "During her hospital course, on Day +43, cellulitis of the right arm was diagnosed and treated empirically with amoxicillin-clavulanate on discharge...Empiric antimicrobial coverage with Meropenem and Vancomycin was given, and she was intubated and admitted to the ICU all on the same day...MRI was consistent with hyperammonemic encephalopathy, prompting initiation of intermittent hemodialysis, lactulose, Rifaximin, and L-carnitine...Empirical doxycycline should be considered first line due to the Ureaplasma resistance to other agents such as Azathioprine...Ureaplasma should be considered in immunocompromised patients in the context of fever of unknown origin and altered level of consciousness, especially if rising serum ammonia levels and soft tissue infections is present. The overall 50% mortality associated with the six cases presented demonstrates the significant risk associated with the infection."

Acute Graft versus Host Disease • Acute Lymphocytic Leukemia • Bone Marrow Transplantation • CNS Disorders • Dermatology • Epilepsy • Graft versus Host Disease • Hematological Malignancies • Hepatology • Immunology • Infectious Disease • Leukemia • Lymphoma • Musculoskeletal Pain • Non-Hodgkin’s Lymphoma • Oncology • Pain • Solid Organ Transplantation • Transplantation

Early Initiation of Kidney Replacement Therapy for Hyperammonemia in Acute Liver Failure: A Case Report and Literature Review (KIDNEY WEEK 2025) - "Standard therapy involves protein restriction, sodium correction, and agents such as lactulose and rifaximin. Conclusion This case illustrates the benefit of early RRT in adult ALF with severe hyperammonemia, regardless of kidney function. It emphasizes a proactive approach and highlights the need for standardized guidelines on RRT initiation and cessation in this setting."

Case report • Clinical • Review • Acute Kidney Injury • CNS Disorders • Hepatology • Liver Failure • Metabolic Disorders • Nephrology • Pediatrics • Renal Disease

Ammonia Beyond Renal Reach: Fatal Cerebral Edema Despite Renal Replacement Therapy in Decompensated Cirrhosis and Small-Bowel Obstruction (KIDNEY WEEK 2025) - "Introduction Hyperammonemia in decompensated cirrhosis is primarily managed through hepatic metabolism and enteric elimination using agents such as lactulose and rifaximin. This case illustrates the critical need for adjunctive or alternative ammonia-lowering strategies in complex presentations. Clinical Timeline"

Bipolar Disorder • CNS Disorders • Diabetes • Epilepsy • Fibrosis • Gastroenterology • Hepatology • Immunology • Metabolic Disorders • Mood Disorders • Psychiatry

Comparison of efficacy of rifaximin, probiotics and L-ornithine L-aspartate in overt hepatic encephalopathy: a randomized, phase IV, lactulose controlled clinical trial. (PubMed, Trials) - P4 | "This randomized controlled trial protocol will compare the efficacy of four proposed groups of medications to fill the gap in current knowledge."

Clinical • Clinical protocol • Journal • P4 data • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Movement Disorders

Hypersensitivity to the lactulose nutrient challenge test in irritable bowel syndrome - a non-invasive test of meal-related symptoms. (PubMed, Am J Gastroenterol) - "The LNCT is useful as a non-invasive and physiologic tool to test GI sensory function in relation to a meal. Moreover, overall GI symptom reporting, visceral hypersensitivity, and hydrogen production are important factors involved in postprandial symptoms in IBS."

Journal • Gastrointestinal Disorder • Immunology • Pain

Improved biosynthesis of lactulose by a novel thermostable cellobiose-2-epimerase generated through semi-rational mutagenesis. (PubMed, World J Microbiol Biotechnol) - "Molecular docking and molecular dynamics (MD) simulation results indicated that the enhanced thermostability of the enzyme was closely related to the structure and rigidity of its flexible loops. The enhanced thermostability allows A242L to tolerate higher temperatures for extended periods, driving the reaction towards lactulose production, which is suitable for industrial lactulose production under harsh conditions."

Journal

Physical capacity modulates intestinal barrier dysfunction in functional disorders: phenotype-specific patterns in fibromyalgia and irritable bowel syndrome. (PubMed, Front Physiol) - "Intestinal barrier function was assessed using serum and fecal zonulin, intestinal fatty acid-binding protein (I-FABP), and the lactulose/mannitol (Lac/Man) urinary excretion test...Intestinal barrier dysfunction in FM and IBS displays phenotype-specific patterns and is significantly modulated by PC. These findings support the integration of PC assessment into clinical phenotyping and highlight potential targets for personalized management of chronic overlapping pain syndromes."

Journal • Fibromyalgia • Gastrointestinal Disorder • Inflammation • Musculoskeletal Pain • Pain • Rheumatology

Prebiotics: types, selectivity and utilization by gut microbes. (PubMed, Int J Food Sci Nutr) - "In early life, human milk oligosaccharides are associated with a Bifidobacterium-dominated ecology and immune development; N-linked and O-linked glycans derived from dietary glycoproteins may exhibit selective utilisation based on binding and species differences; and dietary polyphenols, after limited intestinal absorption, may transform into phenolic metabolites in the colon, shaping the microbiota in a prebiotic-like manner. This review addresses this entire framework, including inulin-type fructans (inulin and fructooligosaccharides), galactooligosaccharides, xylo-oligosaccharides and arabinoxylan-oligosaccharides, isomaltooligosaccharides, lactulose, human milk oligosaccharides, N- and O-linked glycans, and dietary polyphenols as prebiotic-like modulators, with their mechanisms and practical implications."

Journal • Review

CRRT in Nonhepatic Hyperammonemic Encephalopathy After Roux-en-Y Gastric Bypass (KIDNEY WEEK 2025) - "After nutrient and vitamin supplementation, L-carnitine, arginine, sodium phenylbutyrate and lactulose, the arterial ammonia normalized within two weeks. Clinicians faced with a similar clinical case can consider dialysis as an initial therapy. Future research should focus on understanding the role of CRRT dose, timing, and modality in management of patients with hyperammonemia."

Bariatric surgery • Cardiovascular • CNS Disorders • Dermatitis • Dermatology • Epilepsy • Hematological Disorders • Hepatology • Hypertension • Immunology

Hyperammonemia in Adults: Try to Think Outside the Box (SSIEM 2023) - "Lactulose was begun, but after 8 days of therapy for fluctuations in consciousness and severe deterioration, the ammonium was 144 μmol/L, therefore hemodialysis was started... Our cases underline that adults with altered consciousness or encephalopathy must be provided with immediate ammonium measurement, tests for correct differential diagnosis, and eventual prompt treatment to prevent unfavourable evolution. Hyperammonemia from Ureaplasma infection is a known life- threatening complication in Tx and immunocompromised patients, therefore, it is necessary to introduce PCR detection of specific bacteria into follow-up protocols. It should also always be remembered that UCD can begin at any age of life, even in patients with silent anamnesis."

Clinical • CNS Disorders • Infectious Disease • Respiratory Diseases