Abstract
The article presents in-depth analysis of literature data on the multifaceted effects of lactulose and the opportunities for its practical use. History of the study of lactulose therapeutic effects is described. Currently, lactulose as a medicine is registered in more than 100 states. Indications are constipation and hepatic encephalopathy, in some countries — treatment of salmonella carriage. However, the prospects and possibilities for the clinical use of lactulose are very broad.
In 2005, lactulose was officially recognized as the first choice for chronic constipation from the point of view of evidence-based medicine. Mechanism of lactulose action in case of constipation is analyzed; literature data on its safety in pregnant women, children and the elderly are presented.
Lactulose is superior to other treatment options for hepatic encephalopathy. It has been successfully used for any stage of severity of this condition, including latent encephalopathy and hepatic coma. The effectiveness and safety of lactulose in hepatic encephalopathy is confirmed by a large number of high-evidential studies.
Possible indications are: as a prebiotic for the treatment of bacterial overgrowth syndrome, primary and secondary prevention of gallstone disease, for the elimination of endotoxemia in hepatorenal syndrome, exocrine pancreatic insufficiency, hypercholesterolemia. Despite its sweet taste, lactulose is not contraindicated, but, on the contrary, is useful in diabetes.
Contraindications to treatment with lactulose are limited.
The article also presents authors’ own data demonstrating the effectiveness of Medulak in a prebiotic dose in the treatment of chronic pancreatitis with exocrine pancreatic insufficiency combined with bacterial overgrowth syndrome.
Keywords: lactulose, constipation, bacterial overgrowth syndrome, hepatic encephalopathy, diagnostic use