Lactulose chemical structure
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Lactulose

Lactulose (Generlac®, Cholac®, Constilac®, Enulose®, Acilac®) is a synthetic sugar used in the treatment of constipation and liver disease. It consists of the monosaccharides fructose and galactose. more...

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Constipation

In the treatment of chronic constipation, its metabolites draw water into the bowel, causing a cathartic effect through osmotic action.

Hepatic encephalopathy

In treating hepatic encephalopathy, lactulose helps "draw out" ammonia (NH3) from the body. The effectiveness of lactulose is somewhat controversial, and whether or not its effects are through ammonia is also controversial as well. Lactulose is metabolized in the colon by bacterial flora to short chain fatty acids, acidifying the colonic contents. This favors the formation of the nonabsorbable NH4+ from NH3, trapping NH3 in the colon and effectively reducing plasma NH3 concentrations.

Bowel Withholding

Lactulose can be used to treat children that withhold their bowel movements out of fear. The usual dosage is 1 tsp. for each year of the child's age, up to 30 ml. Mixed with juice, it is undetectable and works within four hours.

Side effects

Side effects include diarrhea and resultant dehydration and high sodium levels. In rare cases or with excess amounts can cause stomach pain, gas, vomiting, or diarrhea.

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Guideline for chronic constipation management
From Journal of Family Practice, 11/1/05

American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol 2005; 100:S1-S4.

* Clinical Question

What is the best approach to evaluating and treating chronic constipation?

Study Design Systematic review

Setting Outpatient (any)

Synopsis

This evidence-based guideline is based on a careful accompanying systematic review. Chronic constipation is defined as infrequent or difficult stool passage, incomplete evacuation, prolonged time to stool, or the need for manual maneuvers to pass stool, for at least 3 months. It is estimated that the prevalence of chronic constipation is approximately 15%; it is more common in women.

Patients with alarm symptoms for cancer or bleeding should undergo a thorough diagnostic work-up. Otherwise, routine diagnostic testing is not recommended for patients with chronic constipation who have no alarm symptoms and no signs of organic disorder (such as hypothyroidism) after a careful history and physical examination.

Regarding treatment: of the bulking agents, psyllium increases stool frequency but data are insufficient regarding calcium polycarbophil, methylcellulose, or bran. There is insufficient evidence regarding the efficacy of stool softeners or milk of magnesia. There is good evidence that polyethylene glycol and lactulose both improve stool frequency and consistency.

There are few data regarding stimulant laxatives, but the available data suggest that they are of little benefit. Tegaserod (Zelnorm) improves the frequency and consistency of stools and reduces straining, particular in younger patients. There are insufficient data regarding alternative treatments, herbal supplements, lubricants, or combination laxatives.

* Bottom Line

Diagnostic testing is not needed for most patients with chronic constipation. The evidence is strongest for the efficacy of psyllium, polyethylene glycol, lactulose, and tegaserod. Research is not available to support the routine use of stimulant laxatives, lubricants, stool softeners, calcium polycarbophil, bran, or any herbal products. (LOE=1a)

FAST TRACK Routine diagnostic testing is not recommended for patients without alarm symptoms or signs of organic disorder

COPYRIGHT 2005 Dowden Health Media, Inc.
COPYRIGHT 2005 Gale Group

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