- |||||||||| Auto-brewery Syndrome: Drunk on Carbohydrates (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_2688;
The lactulose breath test was positive for mild hydrogen dominant bacterial overgrowth...She was started on a low carbohydrate diet, probiotics, a 10-day course of amoxicillin-clavulanate, and pantoprazole...Suggested diagnostic modalities include serum lactic acid and alcohol levels during events, breath analyzer tests, carbohydrate challenge tests, and microbial cultures and sensitivities of gut aspirate. Short courses of antimicrobials, probiotics, and low carbohydrate diet modification may result in improvement of symptoms.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
A Lethargic Portosystemic Shunt (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_2639;
However, often surgery or interventional radiology is needed to redirect blood flow to the liver parenchyma which will allow for a more substantial decrease in ammonia levels. The patient in this case was treated with embolization and has been following closely with improvement in his symptoms.Figure: The portosystemic shunt is noted, 1.4cm in width, with drainage into the left renal vein.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Nutritional Deficiencies in Decompensated Cirrhotics with Hepatic Encephalopathy (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_2135;
33/73 were male, and the average MELD score was 15.5 ± 6.3. 32 patients had NASH cirrhosis, 22 had alcoholic cirrhosis, 9 had hepatitis B, C or both and 9 had other diagnoses.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Hemosuccus Pancreaticus: A Mysterious Cause of Gastrointestinal Bleeding (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_2057;
High suspicion for HP in patients with unknown cause of GIB might preclude unnecessary procedures and delay in management.Figure: Fig 1. EGD showing bleeding from the ampulla of Vater
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Hyperammonemic Encephalopathy Secondary to Sigmoid Conduit Urinary Diversion (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_2053;
Our patient did not have concomitant liver disease. In conclusion, hyperammonemic encephalopathy is a rare complication of ureterosigmoidostomy that should be considered in the differential diagnosis of altered mental status.
- |||||||||| lactulose / Generic mfg.
A Rare Care of Pancreatic Neuroendocrine Tumor and Hyperammonemic Encephalopathy (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_2050;
His mental status improved after 2 days of lactulose titrated to 3-4 soft bowel movements daily...It is postulated that the encephalopathy was the result of microvascular portosystemic shunting due to unrecognized hepatic metastases. This case study emphasizes the potential need for advanced imaging in patients with PNET and encephalopathy when initial studies suggest no evidence of hepatic failure.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Refractory Hyperammonemic Encephalopathy Cured With Levocarnitine Infusions (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_1586;
Lactulose was held due to chronic diarrhea...In such cases, the clinician should consider alternative causes of hyperammonemic encephalopathy, such as LC deficiency. It can be cured with infusions, and resulted in significant improvement in quality of life, independence, and prognosis for this patient.
- |||||||||| lactulose / Generic mfg., piperacillin sodium/tazobactam sodium / Generic mfg.
Postrenal Acute Renal Failure Secondary to Fecaloma, An Unusual Entity (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_1085;
Patient refused manual disimpaction and enemas so lactulose was started...Sigmoid colon and rectum are the two regions where fecaloma is frequently seen. Due to the local pressurizing effect of fecaloma (pelvic mass effect), severe morbidity such as urinary system obstruction and rupture of colon or bladder may occur, and sometimes they can be mortal.Figure: Non-contrast CT scan showing giant fecaloma impacting urinary bladder.
- |||||||||| lactulose / Generic mfg., paracetamol / Generic mfg.
Spontaneous Retroperitoneal Bleeding in a Patient With Newly Diagnosed Cirrhosis of the Liver (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_797;
Hepatitis panel, drug screen, and acetaminophen levels were unremarkable...He received lactulose for presumed hepatic encephalopathy...Patients with cirrhosis, especially on anticoagulation, who develop hemodynamic instability with or without abdominal pain, flank pain, or the classic findings including Grey-Turner or Kehr signs deserve consideration and work-up for spontaneous retroperitoneal bleeding as the mortality rate remains high.Figure: A. Transverse view of the CT angiogram revealing large left-sided retroperitoneal hemorrhage with an area of increased density within the collection representing a focal area of active extravasation.B. Coronal view of the CT angiogram revealing a large left retroperitoneal hemorrhage extending from the undersurface of the diaphragm into the left inguinal canal measuring approximately 10.1 x 13.8 x 37.6 cm with associated cirrhosis and abdominal ascites present.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Spontaneous Splenorenal Shunt (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_637;
In conclusion, SPSS may be an important marker for dangerous complications associated with portal hypertension, even with a preserved hepatic function (MELD score < 10). SPSS should be considered part of the criteria for referral to a liver transplant center in those who are potential candidates.Figure: SPSS
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
A Crippling Presentation of Cirrhosis (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_594;
We encourage initial evaluation with liver enzymes and further work up as indicated if a patient with hemiparesis is negative for acute stroke.Figure: Figure 1. Micronodular appearance of the liver with numerous scattered hypodensities
- |||||||||| Acute Hepatitis B Infection Presenting as Hepatic Encephalopathy Induced Seizure (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_592;
Initial bloodwork revealed ALT 1040 U/L, AST 1005 U/L, ALP 172 U/L, total bilirubin 14.6 mg/dL, acetaminophen level < 7 ug/dL, and an ammonia level of 76 μmol/L in labs drawn prior to seizure event...Patient began tenofovir and levetiracetam with outpatient gastroenterology and neurology follow up...Once acute hepatitis B infection was found to be the cause of the neurological dysfunction, we were able to treat her appropriately with lactulose and subsequently tenofovir. In conclusion, hepatobiliary pathology must be considered in patients who present with altered mental status and seizure or the etiology may be missed, resulting in poor patient outcome.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
A Rare Case of Acute Fulminant Liver Failure Caused by Body Building Supplements (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_380;
Lab Work was significant for a total bilirubin at 26.9, AST 2829, ALT 3091, ammonia level 80, WBC count of 3.6, hemoglobin at 14.8, platelets 227,00, INR 6.4, PTT of 76.3 and tylenol level of 10...He started on lactulose and xifaxan...This case highlights the need for future studies that show accurate dosing for athletes in order to avoid liver toxicity as well as the importance of FDA regulations of such supplements. It is also important for physicians to keep in mind rarer causes of liver failure.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Successful Treatment of Refractory Hepatic Encephalopathy With Embolization of Splenorenal Shunt (Shoreline Exhibit Hall) - Sep 8, 2021 - Abstract #ACG2021ACG_147;
Large portosystemic shunts can also develop in these patients and are thought to contribute to refractory hepatic encephalopathy. Hence, proper evaluation should be performed in these patients to diagnose portosystemic shunts as embolization can improve outcomes as was demonstrated in this case.
- |||||||||| lactulose / Generic mfg.
An unusual presentation of acute confusion state- Manganese Madness (Encephalopathy) (Posters) - Sep 7, 2021 - Abstract #EUSEM2021EUSEM_832;
Patient was started on fluids, antibiotics, lactulose enema, thiamine, and anti-hyperkalemia measures...Treatment includes removal of the patient from the source exposure, Chelation therapy using CaNa2EDTA (EDTA) and Para-amino salicylic Acid (PAS) Older patients often develop more significant toxicity than younger patients and the prognosis is more related to morbidity than mortality. ADDITIONAL INFORMATION: In summary, diagnosis requires a high clinical suspicion, recognition of the risk factors, early usage of MRI and a team-based approach.
- |||||||||| lactulose / Generic mfg.
Clinical, Journal: How is small bowel permeability in endometriosis patients? a case control pilot study. (Pubmed Central) - Aug 29, 2021
To clarify this hypothesis, we measured SB permeability through plasma values of LPS and urinary secretion of lactulose (La), mannitol (Ma) and their ratio (L/M) in patients with endometriosis compared with healthy controls (HC)...Patients reported higher levels of pelvic chronic pain (3.87 ± 2.99 vs 0.15 ± 0.55; pe = 0.001) and significantly higher LPS plasma levels (0.529 ± 0.11 vs 0.427 ± 0.08; p value = .027) than HC. Our results indicate that intestinal permeability is abnormal in endometriosis patients, and it might play a role in the pathogenesis of this chronic disease.
- |||||||||| lactulose / Generic mfg.
Preclinical, Journal: Dietary intervention with sialylated lactulose affects the immunomodulatory activities of mice. (Pubmed Central) - Aug 26, 2021
Comparing the differences of these 4 sialylated lactuloses in affecting immunity in mice revealed that Kdnα2,3lactulose had the best overall performance in influencing cytokine expression, cell immunity, humoral immunity, and nonspecific immunity. This study provides critical support for use of sialylated lactuloses as potential immunomodulators in foods.
- |||||||||| lactulose / Generic mfg.
Journal: Mucosa-Associated Microbial Profile Is Altered in Small Intestinal Bacterial Overgrowth. (Pubmed Central) - Aug 24, 2021
We investigated the microbial communities of mucosal specimens from the duodenum, ileum, sigmoid colon, and feces of patients with and without SIBO, as diagnosed by lactulose breath testing...Furthermore, we identified mucosa-associated taxa that may be potential biomarkers or therapeutic targets of SIBO. Further investigation is needed on their mechanisms and roles in SIBO.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Clinical, Journal: Propranolol-induced hallucinations mimicking encephalopathy in a patient with liver cirrhosis. (Pubmed Central) - Aug 20, 2021
Upon follow-up, the patient was clinically stable but had developed visual and auditory hallucinations which raised the suspicion that HE was not the cause. CT scan of the brain was unremarkable and the hallucinations were considered to be caused by Propranolol and disappeared shortly after switching to Carvedilol.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
[VIRTUAL] Diagnosing and Treating Early Hepatic Encephalopathy () - Aug 19, 2021 - Abstract #APDW2021APDW_672;
The pathogenesis of MHE is considered similar to that of overt HE and ammonia plays a key role. Thus ammonia lowering agents such as lactulose, L-ornithine and L- aspartate, probiotics and rifaximin have shown good results in many trials.
- |||||||||| lactulose / Generic mfg.
Review, Journal: Low-Dose Lactulose as a Prebiotic for Improved Gut Health and Enhanced Mineral Absorption. (Pubmed Central) - Aug 14, 2021
This review provides an overview of the preclinical and clinical evidence published to date showing that low-dose lactulose stimulates the growth of health-promoting gut bacteria, inhibits the growth of pathogenic bacteria, increases the production of beneficial metabolites, improves mineral absorption, and has good overall tolerability. Implications of these data for the use of lactulose as a prebiotic are also discussed.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
[VIRTUAL] Prebiotic lactulose as efficacious microbiota and metabolite modulator in cirrhosis environment (Room: Zoom Room 24) - Aug 13, 2021 - Abstract #ACSFall2021ACS_Fall_8792;
These shifts in metabolite production are indicative of carbohydrate fermentation and are consistent with improved gut health and reduced risk of HE.We demonstrated that lactulose is able to significantly increase the relative abundance and absolute numbers of bifidobacteria, which was associated with an increased production of SCFA and a reduction in ammonia content. Future investigations should assess the molecular pathways that are involved in the modulation of gut microbiota and its metabolic reprogramming while translational studies should examine the clinical potential of this in vitro observations.
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