What is the first-line treatment for hepatic encephalopathy in cirrhosis patients?

Lactulose is recognized as the first-line treatment for hepatic encephalopathy in patients with cirrhosis due to its effectiveness in reducing ammonia levels in the bloodstream. Hepatic encephalopathy is a neuropsychiatric disorder that occurs as a result of the liver's inability to detoxify substances, leading to a buildup of ammonia and other toxins. Lactulose is a non-absorbable disaccharide that serves to trap ammonia in the gut, promoting its excretion through diarrhea. This mechanism helps to lower serum ammonia levels, addressing the underlying cause of the encephalopathy and providing symptomatic relief.

Lactulose also encourages the growth of beneficial gut bacteria, which can further help in reducing ammonia production in the intestines. This dual action—both promoting the excretion of ammonia and altering the gut flora—makes lactulose a cornerstone in the treatment of this condition.

Other options, such as cholestyramine, diuretics, and protein restriction, do not provide the same direct benefit in managing hepatic encephalopathy. Cholestyramine is primarily used for binding bile acids and does not effectively reduce ammonia. Diuretics are generally used to manage fluid overload in cirrhotic patients but do not address the complication of hepatic