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At least 19 recordsLinked to original sources
PubMed1993

Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose?

Twelve healthy volunteers were studied for two test periods, at the beginning of which they ingested a diarrheogenic load (60 g) of lactulose in 350 mL water with 10 g polyethylene glycol 4000 (PEG); the two periods were separated by a lactulose feeding period of 8 d, during which a nondiarrheogenic load (20 g) of lactulose was taken twice daily. The transit time and flow rates of water and lactulose in the distal ileum of four subjects were not different before and after the lactulose feeding period. In the other eight subjects, stool weight and frequency, fecal pH, and fecal outputs of carbohydrates and osmotic moieties after the ingestion of 60 g lactulose dropped significantly (P < 0.05) after the lactulose feeding period, whereas the orofecal transit time and fecal concentrations of beta-galactosidase and lactic acid increased (P < 0.05). We conclude that changes in colonic function induced by prolonged exposure to a nondiarrheogenic amount of lactulose mitigate the severity of the diarrhea because of the larger dose of lactulose.

Adult↗
PubMed1997

Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit: lactulose accelerates small bowel transit.

UNLABELLED: The lactulose breath test (LBT) and gastroenterocolonic scintigraphy (GECS) can both be used to measure orocecal transit time (OCTT). The aims of this study were (1) to measure OCTT by LBT and GECS and (2) to determine whether lactulose alters orocecal transit. METHODS: Eight normal subjects underwent simultaneous breath hydrogen testing, GECS, and duodenal manometry while receiving either 10 g lactulose or placebo with a radiolabeled solid/liquid test meal during two studies. There was a good correlation between OCTT by LBT and GECS when performed simultaneously (r = 0.95; P < 0.001). OCTT by GECS with lactulose was significantly faster (P = 0.004) than by GECS without lactulose, despite no change in gastric emptying of liquids and slowing of gastric emptying of solids (P = 0.02). The postprandial duodenal motility index was greater with lactulose than with placebo (P = 0.031). This study demonstrates that LBT and GECS (without lactulose) are not equivalent measures of OCTT. The standard LBT accelerates OCTT and slows gastric emptying. Therefore, lactulose has a direct accelerating effect on small intestinal transit.

Adult↗
PubMed1987

Nitrogen in fecal bacterial, fiber, and soluble fractions of patients with cirrhosis: effects of lactulose and lactulose plus neomycin.

To determine how lactulose and lactulose plus neomycin might alter nitrogen metabolism in the colon we investigated the effect of these agents on the distribution of nitrogen in the bacterial, soluble, and fiber fractions of stool. The alterations in fecal nitrogen excretion were additionally correlated with changes in total body urea synthesis and degradation rates. Six patients with stable cirrhosis received a control diet alone followed by the administration of lactulose (56 +/- 6 gm/day), and eight similar patients received lactulose alone (63 +/- 5 gm/day) followed by the addition of neomycin (4 gm/day). Their feces were partitioned into individual fractions by physical separation. Lactulose administration increased nitrogen excreted in the bacterial fraction by 165% (from 0.52 +/- 0.14 gm/day to 1.38 +/- 0.21 gm/day) and by 135% in the soluble fraction (from 0.58 +/- 0.08 gm/day to 1.36 +/- 0.23 gm/day). When lactulose was supplemented with neomycin, the nitrogen content of the bacterial fraction decreased by 28%. Lactulose caused a 23% reduction in the urea production rate that was mainly accounted for by increase in fecal nitrogen excretion. The addition of neomycin caused a further reduction in urea production that was explained by an inhibition of urea degradation. These results demonstrate that a major effect of lactulose was to augment the incorporation of nitrogen into fecal bacteria although nitrogen in the soluble fraction also increased. The additional nitrogen excreted in the fecal bacterial and soluble fractions caused a reduction in urea synthesis.

Aged↗
PubMed1985

Influence of chronic lactulose ingestion on the colonic metabolism of lactulose in man (an in vivo study).

The effects of a chronic load of nonabsorbable sugars on intracolonic bacterial metabolism of carbohydrates and on H2 breath excretion are disputed. However, most of the discussion relies on indirect evidence or on results of in vitro studies. Thus, we attempted to assess directly and in vivo the effects on intracolonic metabolism of lactulose of a chronic oral load of this nonabsorbable disaccharide. 20 g of lactulose was given orally twice daily during 8 d to eight normal volunteers. In all, breath H2 concentration was measured on days 1 and 8 after ingestion of the morning lactulose dose. In four subjects, stools were collected during 2 d at the beginning and at the end of the lactulose maintenance period to measure fecal pH and daily outputs of carbohydrates and beta-galactosidase. The four other subjects were intubated on days 1 and 8 to measure the pH and the concentrations of carbohydrates, lactic acid, and volatile fatty acids (VFA) in the distal ileum and cecal contents. Moreover, 14C-lactulose was added to cold lactulose and 14CO2 breath outputs determined. Pulmonary H2 excretion fell from day 1 to day 8 (P less than 0.05), whereas 14CO2 excretion increased (P less than 0.01). Fecal water pH, lactic acid, and VFA concentrations did not vary between the two stool collection periods. 24-h fecal weight, fecal water, and carbohydrate outputs showed a trend to decrease between days 1 and 2 and days 7-8, whereas beta-galactosidase activity rose markedly (P less than 0.01). No significant variations were observed for all parameters measured in ileal fluid. In the cecum, areas under the concentration curves decreased from day 1 to day 8 for lactulose, galactose, and fructose (P less than 0.01), while an increase was found for lactic acid (P less than 0.001), acetic acid (P less than 0.0001), and total VFA (P less than 0.001). Cecal fluid pH dropped faster (P less than 0.05) and to a lower level (P less than 0.05) on day 8 than on day 1. These data clearly show that a chronic load of a nonabsorbable sugar induces changes in colonic bacterial metabolic pathways resulting in a better efficiency of the flora to digest the carbohydrate.

Adult↗
PubMed1987

Effect of long term lactulose ingestion on secondary bile salt metabolism in man: potential protective effect of lactulose in colonic carcinogenesis.

This study investigated whether colonic absorption of secondary bile acids, especially deoxycholate in patients with adenomas could be decreased by oral lactulose. Bile acid metabolism was studied using bile sampling and 14C-deoxycholate kinetics in patients with colonic adenomatous polyps before and after four and 12 weeks of lactulose, 60 g/day. The results indicate that lactulose decreased the deoxycholate pool size from a mean of 22.0 (SD: +/- 13.8) to 14.3 (+/- 7.6) mumol/kg (p less than 0.025). Deoxycholate absorption fell from 3.8 (+/- 2.3) to 2.9 (+/- 1.4 mumol/kg/d (ns). The biliary bile acid composition decreased significantly in deoxycholate after four and 12 weeks with a rise in primary bile acids. There was a highly significant correlation between the %-change in DCA input and the %-change in DCA pool size (r = 0.89). Intestinal transit measured by the pellet method (4.1 +/- 1.9 to 2.4 +/- 0.6 day; p less than 0.01) and faecal pH decreased, while stool frequency and weight rose significantly. Significant correlations between the %-change in gut transit time and the %-change in DCA pool size or %-change in DCA input were absent. The results show that it is possible to lower colonic secondary bile acid absorption by long term lactulose feeding. This effect can be mediated by accelerated transit and the acidification of the colonic contents.

Administration, Oral↗
PubMed1990

[Infantile constipation and Allomin-lactulose. Treatment of infantile obstipation in infants fed with breast milk substitutes. A controlled clinical trial of 2 per cent and 4 per cent Allomin-lactulose].

The Authors investigated the effects of Allomin with admixture of 2% and 4% lactulose on constipation in infants aged 0-6 months reared on breast-milk substitutes. The investigation was randomized and double-blind and was carried out during the period 1.4.1987-31.7.1988 on non-hospitalized infants in the counties of Funen and North Jutland in cooperation with the health visitors in these regions. Constipation was defined as hard and difficult defaecation and the trial period lasted for 14 days. Parents of the infants who participated classified the infants' motions according to consistence and degree of difficulty in defaecation on special forms. A total of 220 children participated and these received, after randomizing, either Allomin-lactulose 2% or 4% as the only breast-milk substitute during the period of observation. The effect of treatment was defined as "no constipation" i.e. all motions during 24 hours described as easy and of normal or thin consistence. In addition, the effect was measured by the parents' general impression of what the infant thrived best on. With both of the preparations, treatment was effective in over 90% of the infants in both the groups without significant difference. The effect occurred gradually and, in some cases, up to 8-10 days after initiation of treatment without significant difference in the rate of effect between the groups. After the effect had commenced, significantly fewer thin motions occurred in the 2% group than in the 4% group. 92% of the infants in the 2% group and 91% in the 4% group wanted to continue the Allomin-lactulose preparation rather than the usual breast-milk substitute. A retrospective questionnaire to parents of 97 infants who had continued with Allomin-lactulose 2% was answered by 84.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Feeding↗
PubMed2004

Transformation of lactulose trihydrate into anhydrous lactulose by fluidized bed drying and its characterization.

Stable anhydrous lactulose was produced from lactulose trihydrate by stepwise heating on a fluidized bed. The processes were performed on stable powder forms. The anhydrous lactulose was characterized by an opaque white appearance, a coarse surface structure with random cracks and indentations, a high degree of crystallization, stability under humid conditions, and by X-ray powder diffraction, differential thermal analysis, and differential thermogravimetry. Those characteristics were different from those of the original trihydrate, which was transparent, had a smooth surface and a higher degree of crystallization, was stable under humid conditions and had different X-ray powder diffraction, differential thermal analysis, and thermogravimetric characteristics. The transformation was enhanced when the inlet temperature was 45-55 degrees C or when the temperature of the fluidized bed was over 40 degrees C. At these cutoff temperatures, both crystalline forms were observed.

Crystallization↗
PubMed2001

[Disturbance of liver functions and dysbiosis in patients with lipid distress syndrome and its treatment with lactulose preparation "Duphalac" (lactulose)].

Disturbances of liver's functions and its connection with microflora pathology of large intestine were examined in the patients with lipid dysstress-syndrome. Severe dysbiosis (reduce of light fatty acids level and increase of anaerobe index) was revealed. Efficiency of "Dufalak" (lactulose disaccharide) on liver's functions was estimated.

Adult↗
PubMed2003

[Effects of lactulose treatment on the course of subclinical hepatic encephalopathy].

OBJECTIVE: To observe the natural history of subclinical hepatic encephalopathy (SHE) and to compare the efficacy of long-term and short-term treatment of lactulose. METHODS: Sixty SHE patients with abnormal psychometric tests performance and/or evoked potentials were randomly divided into 3 groups of 20 cases: control group (given vitamin B complex only for 24 weeks), short-term lactulose group (administered orally with lactulose 15 - 90 ml/d for 8 weeks in addition to vitamin B complex as described above), and long-term lactulose group (administered orally with lactulose 15 - 90 ml/d for 24 weeks in addition to vitamin B complex as described above). Blood ammonia, liver function, number connection test (NCT), digital symbol test (DST), quality of life, and somatosensory evoked potential (SEP) were investigated 0, 8, 16, and 24 weeks after the onset of experiment. The incidence of HE was recorded. RESULTS: No statistically significant difference was found in terms of liver function score of ENVER, and SEP any time after the onset of the experiment (all P > 0.05). Eight weeks after the onset of experiment the performance of NCT and DST was significantly improved in the 2 lactulose groups than in the control group (both P < 0.05), without significant difference between the two treatment groups (P > 0.05). However, significant difference failed to appear in blood ammonia 8 weeks after, and began to be found since the 16th week between the control group and long-term lactulose group (P < 0.05). Since the 16th week the condition of the long-term lactulose group was much better than those of the other 2 groups in terms of blood ammonia, NCT performance, scores of PHYS, PSYCH, and SCOIL (all P < 0.05), and not in DST performance (P > 0.05). 24 weeks after, the condition of the long-term lactulose group was still better than those of the other 2 groups (all P < 0.05), however, no significant difference was found in terms of the above-mentioned indicators between the control and short-term lactulose groups (all P > 0.05). The HE prevalence of the control, short-term lactulose, and long-term lactulose groups were 40%, 30%, and 5% respectively 24 weeks after, with a significant difference between the long-term lactulose group and between any of the other groups (both P < 0.05) and without a statistically significant difference between the control and short-term lactulose groups (P > 0.05). CONCLUSION: Long-term lactulose treatment lowers blood ammonia and improves the psychometric performance and quality of life, thus lowering the prevalence of clinical HE. However, short-term lactulose treatment fails to improve of the natural course of HE.

Administration, Oral↗
PubMed2003

[Possible interesting dietetic effects of lactulose as a feed additive in pig feed].

In reared piglets (n = 10), fattening pigs (n = 20) and sows (n = 8) the effects of lactulose as feed additive on the quality and composition of chyme and faeces were tested to find out potential dietetic advantages of its use. The lactulose concentration in the diets varied between 27-29 g/kg dry matter in piglets and fattening pigs and 55-140 g/kg dry matter in the diet of sows. In piglets and fattening pigs the lactulose intake did not alter the dry matter content and pH in faeces; in spite of the higher concentration lactulose did not result in diarrhea in sows or adult minipigs, there was only a slight decrease in the dry matter content of faeces. In contrast to findings in human beings only traces of lactulose reached the hind gut, although higher lactulose concentrations were measured at the end of the small intestine (in piglets: 10-40 g, in fattening pigs 40-70 g lactulose per kg dry matter of chyme). The oral intake of lactulose did not increase the concentration of lactic acid or volatile fatty acids in the content of the small intestine and did not reduce the pH in the chyme, but in the contents of cecum and colon ascendens higher concentrations of volatile fatty acids were measured (in piglets: significantly higher values, in fattening pigs slightly increased concentrations). In piglets as well as in fattening pigs lactulose resulted in reduced concentrations of ammonia in the content of small and large intestine, further more the concentrations of lipopolysaccharides were increased in the colonal chyme, when pigs ingested the lactulose containing diet. Due to the fact that only small amounts of lactulose reached the hind gut there are doubts, whether lactulose has comparable dietetic effects in pigs as known from human beings (for example laxative effects, forced elimination of bacteria like salmonella). The results obtained here in pigs underline the necessity of experimental studies in the target species (including parameters of digestive physiology, chemical/microbial composition of the chyme) before substances are used and recommended for dietetic purposes in feeding practice. In spite of generally adopted similarity of the alimentary tract in pigs and human beings there are eventually some important differences within the intestine, its digestive capacity or in reactions on ingested substances leading to unexpected results.

Animal Feed↗
PubMed1995

Treatment of porto-systemic encephalopathy with lactitol verus lactulose: a randomized controlled study.

BACKGROUND: Lactitol (beta-galactosido-sorbitol), a novel disaccharide analogue of lactulose, has been suggested as an alternative to lactulose in the treatment of portosystemic encephalopathy (PSE) in Western country. In order to assess its therapeutic effect and adverse reaction in PSE in the Chinese, we conducted this study. METHODS: Forty-one patients with PSE were enrolled in this study. Patients were randomly divided into 2 groups to receive lactitol (n = 21) or lactulose (n = 20) for 5 days. The doses of both drugs were adjusted to keep daily bowel movement of 2 to 3 times. The PSE index (mental state, EEG, asterixis, number connection test [NCT], and ammonia) was evaluated in each patient before and after treatment. Daily doses of lactitol and lactulose, stool frequency, and side effect were recorded. RESULTS: The mean dose of lactitol used was 66.3 +/- 36.4 gm and that of lactulose was 56.9 +/- 32.1 ml of lactulose. The majority of patients (37/41) gained clear consciousness after 5 days' treatment. In the lactitol group, blood ammonia, EEG, NCT, asterixis, mental status and PSE index before treatment were 208 +/- 62 micrograms/ml, 2.9 +/- 0.8, 4.0 +/- 0.0, 2.7 +/- 1.5, 2.9 +/- 0.7 and 77.1 +/- 10.5, respectively. All parameters decreased significantly after 5 days' treatment (119 +/- 50 micrograms/ml, 1.1 +/- 1.0, 2.9 +/- 1.2, 1.7 +/- 1.1, 0.7 +/- 0.7, and 34.4 +/- 16.0, p < 0.05). The lactulose group had the similar results. However, the improvement of PSE index after therapy in the lactitol group was significantly higher than that in the lactulose group (42.7 +/- 19.3 vs 31.1 +/- 13.7, p < 0.05). In addition, more patients in the lactitol group than in the lactulose group (67% vs 20%, p = 0.003) favored the taste of their assigned drugs. No patient who received lactitol experienced any side effects; however, six patients treated with lactulose complained of meteorism and flatulence, and four complained of nausea. CONCLUSIONS: Both lactitol and lactulose are effective in the treatment of PSE, though the effect of lactitol seems slightly superior to that of lactulose in our study. Lactitol is more acceptable to our patients due to better palatability and less side effects. Lactitol is another good alternative in the treatment of PSE.

Aged↗
PubMed1989

Reproducible lactulose hydrogen breath test as a measure of mouth-to-cecum transit time.

Breath hydrogen monitoring after oral lactulose syrup is a conventional measure of mouth-to-cecum transit time (MCTT), but its reproducibility has been questioned. We compared the reproducibility of five measurements of MCTT after a conventional breakfast (380 kcal) taken with tea containing 20 g lactulose to five measurements of MCTT after 20 g lactulose in water in eight normal volunteers. Individual mean breakfast transit time was not significantly different from lactulose transit time in each of the seven subjects, but one had a breakfast transit time of 151 +/- 15 min and a lactulose transit time of 86 +/- 22 minutes (X +/- SD, P less than 0.001). The coefficient of variation of breakfast transit time (11.6 +/- 5.3%, range: 6.9-24.2%) was less than that of lactulose transit time (30.7 +/- 7.8%, range: 22.1-50.0%, P less than 0.001). In a second set of experiments, the liquid phase marker (99mTechnetium-diethylene triamine pentaacetic acid) emptied from the stomach more rapidly after the lactulose solution (T1/2 16.3 +/- 5.4) than after the breakfast (33.9 +/- 10.9 min, P less than 0.01) and MCTT was shorter after lactulose (77 +/- 32 vs 104 +/- 40 min, respectively, P less than 0.05). There was no correlation between MCTT of lactulose and breakfast and between half-time gastric emptying and MCTT of either lactulose or breakfast. We conclude that the ingestion of inert lactulose induces an abnormally rapid MCTT and that breakfast MCTT is a much more reproducible investigation and should be employed in studies requiring serial measurements.

Adult↗
PubMed1990

Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose.

PURPOSE: The purpose of this study was to evaluate the use of sorbitol as an inexpensive alternative to lactulose for treating constipation in the elderly. PATIENTS AND METHODS: Thirty men aged 65 to 86 with chronic constipation were studied in a randomized, double-blind, cross-over trial in which lactulose and 70% sorbitol (0 to 60 mL daily) were each given for 4 weeks preceded by a 2-week washout period. RESULTS: The average number of bowel movements per week was 6.71 with sorbitol and 7.02 with lactulose (95% confidence interval of the difference: -0.43 to 1.06), and the average number of days per week with bowel movements was 5.23 with sorbitol and 5.31 with lactulose (95% confidence interval of the difference: -0.32 to 0.48). Eleven patients stated a preference for sorbitol, 12 for lactulose, and seven had no preference. On a visual analogue scale measuring severity of constipation (0 to 100 mm), the average score for sorbitol was 35.6 mm versus 37.1 mm for lactulose (95% confidence interval of the difference: -6.4 to 9.3). The sorbitol and lactulose treatment periods were also similar in percent of bowel movements recorded as "normal," frequency and severity of symptoms such as bloating, cramping, and excessive flatulence, and overall health status as assessed by a previously validated five-category questionnaire. There were no significant differences between sorbitol and lactulose in any outcome measured except nausea, which was increased with lactulose (p less than 0.05). CONCLUSION: These results support the hypothesis that sorbitol and lactulose have no clinically significant differences in laxative effect. Sorbitol can be recommended as a cost-effective alternative to lactulose for the treatment of constipation in the elderly.

Aged↗
PubMed1997

Increasing the intestinal resistance of rats to the invasive pathogen Salmonella enteritidis: additive effects of dietary lactulose and calcium.

BACKGROUND AND AIMS: Lactulose fermentation by the intestinal microflora acidifies the gut contents, resulting in an increased resistance to colonisation by acid sensitive pathogens. The extent of fermentation should be controlled to prevent acid induced epithelial cell damage. Considering the buffering capacity of calcium phosphate and its intestinal cytoprotective effects, whether supplemental calcium phosphate adds to the increased resistance to intestinal infections by lactulose fermentations was studied. METHODS: In a strictly controlled experiment, rats were fed a purified low calcium control diet, a low calcium/lactulose diet, or a high calcium/lactulose diet, and subsequently infected orally with Salmonella enteritidis. RESULTS: Lactulose fermentation lowered the pH and increased the lactic acid concentration of the intestinal contents, which significantly reduced excretion of this pathogen in faeces; thus it improved the resistance to colonisation. This agreed with the high sensitivity of S enteritidis to lactic acid (main metabolite of lactulose fermentation) in vitro. Calcium phosphate decreased translocation of S enteritidis to the systemic circulation, an effect independent of lactulose. The unfavourable increased cytotoxicity of faecal water caused by lactulose fermentation was more than counteracted by supplemental calcium phosphate. Moreover, calcium phosphate stimulated lactulose fermentation, as judged by the reduced lactulose excretion in faeces and increased lactic acid, ammonia, and faecal nitrogen excretion. CONCLUSION: Extra calcium phosphate added to a lactulose diet improves the resistance to colonisation and translocation of S enteritidis. This is probably mediated by a calcium induced stimulation of lactulose fermentation by the intestinal microflora and reversion of the lactulose mediated increased luminal cytotoxicity, which reduces damage inflicted on the intestinal mucosa.

Animals↗