ArticleDigestive diseases and sciences2023
Barriers to Lactulose Adherence in Patients with Cirrhosis and Hepatic Encephalopathy.
Article in Digestive diseases and sciences, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 8 citations in OpenAlex.
- Berberine and lactulose combination therapy attenuates neuroinflammation and hepatic injury in thioacetamide-induced hepatic encephalopathy in rats.Metabolic brain disease · 2026Article
- Reducing the Risk of Overt Hepatic Encephalopathy Recurrence: A Narrative Review.Journal of clinical and translational hepatology · 2026Review
- Management of Refractory Hepatic Encephalopathy.Digestive diseases and sciences · 2026Review
- Understanding Hepatic Encephalopathy: Patient Knowledge, Adherence, and Barriers to Care in Cirrhosis.Cureus · 2026Article
- Deploying and Examining Beacon for At-Home Patient Self-Monitoring with Critical Flicker Frequency.Proceedings of the SIGCHI conference on human factors in computing systems. CHI Conference · 2025Article
- Future Therapies of Hepatic Encephalopathy.Clinics in liver disease · 2024Review
- Sociodemographic disparities in documented nonadherence to medication for hepatic encephalopathy: a National Inpatient Sample analysis.Annals of gastroenterologyArticle
- Gut microbiome profiles to exclude the diagnosis of hepatic encephalopathy in patients with cirrhosis.Gut microbesArticle
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundHepatic encephalopathy (HE) is a major cause of mortality and morbidity in patients with cirrhosis. Lactulose non-adherence is one of the most frequently reported precipitants of hospital admission for HE.
aimsWe aimed to identify which factors contribute most to lactulose non-adherence and propose strategies to promote greater adherence and utilization of lactulose.
methodsParticipants in this study consisted of patients with cirrhosis who were taking lactulose for prevention of HE. Subjects were administered the Morisky Adherence Scale 8 (MAS-8) and a customized 16-question survey that assessed barriers to lactulose adherence. Results from the MAS-8 were used to stratify subjects into "adherent" and "non-adherent" groups. Survey responses were compared between groups.
resultsWe enrolled 129 patients in our study, of whom 45 were categorized as "adherent and 72 were categorized as "non-adherent." Barriers to adherence included large volumes of lactulose, high frequency of dosing, difficulty remembering to take the medication, unpleasant taste, and medication side-effects. Most patients (97%) expressed understanding of the importance of lactulose, and 71% of patients felt that lactulose was working to manage their HE. Hospital admission rates for HE was higher in non-adherent patients, although this difference was not statistically significant.
conclusionWe identified several factors that contribute to lactulose non-adherence among patients treated for HE. Many of these factors are potentially modifiable. Patient and care-giver education are critical to assure adherence. Pharmacists and nurses are an essential but underutilized aspect of education regarding proper medication use.
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