HOW DOES LACTULOSE RESTORE BOWEL FUNCTION?

As an ideal laxative for young children, it was first described by F. Mayerhofer and F. Petuely in 1959.

A large number of studies have been conducted that have deciphered the mechanism of action and confirmed the effectiveness of lactulose in constipation.

The mechanism of action in constipation is reduced to an increase in the concentration of short-chain carboxylic acids of the aliphatic series, which:

a) reduce the intraintestinal pH level and, as a result, stimulate intestinal motility;

b) increase the osmotic pressure of the intestinal contents, which contributes to fluid retention, liquefaction of chyme, an increase in its volume and activation of intestinal peristalsis.

A certain importance is given to increasing the biomass of saccharolytic microflora, which also increases the volume of intestinal contents.

Thus, taking lactulose, unlike other laxatives, leads to the simultaneous correction of two main pathophysiological mechanisms of constipation:

1) stimulates the motor activity of the colon;

2) increases the volume and softens intestinal chyme. The drug does not have an irritating effect on the intestinal mucosa, has a positive effect on the composition of intestinal microflora.

In terms of its effects, it is close to dietary fiber, which is the main ingredient of food additives used for constipation.

Lactulose, due to its safety, can be used to normalize bowel movements in children and adults, in elderly and senile people with pathologies of various organs and systems, in pregnant and breastfeeding women, in patients taking medications that cause constipation.

Lactulose is the drug of choice for facilitating the act of defecation in hemorrhoids, anal fissures, perianal thrombosis, in large hernias, after surgical interventions, in patients who are on bed rest. In these situations, the drug provides stool softening and a decrease in the strength and duration of straining during the act of defecation.

The daily dose, time and frequency of taking lactulose in the treatment of constipation are selected individually. Depending on the frequency of bowel movements, the time of the act of defecation and the consistency of the stool, the dose of the drug is either increased on average to 60 ml (40 g), or reduced and the optimal timing and frequency of administration are established. With a normally selected dose of lactulose, defecation is observed from 3 to 7 times a week, with the presence of soft, formed or mushy feces (from 300 to 500 g/day). The duration of treatment is on average 2 months with a subsequent reduction in the dose of the drug and complete cancellation of the drug. In a number of patients, taking lactulose helps restore bowel function for a long time.

Thus, lactulose for constipation acts similarly to dietary fiber, is a source of nutrients for the epithelium of the mucous membrane of the colon, normalizes the composition of the intestinal microflora, tolerance does not develop to it, and there is no withdrawal syndrome. The drug is effective in constipation of any etiology and pathogenesis. However, it should be noted that a temporary increase or appearance of flatulence is possible in some patients, which significantly decreases during treatment. In patients with spastic dyskinesia of the colon, pain syndrome may increase.

A positive effect was obtained in gastrointestinal tract infections, in particular, caused by Yersinia, Shigella, rotavirus infections.

Lactulose has a number of positive metabolic effects on the body, and therefore it can be used in such completely different diseases as:

- urinary tract infection,

- gallstone disease,

- hypercholesterolemia,

- chronic renal failure,

- and also as a prebiotic to restore the normal composition of intestinal microflora after antibiotic therapy, radiation and chemotherapy.

The therapeutic effect of lactulose in the above conditions is based on an increase in the growth of saccharolytic and, in particular, bifidum bacteria, inhibition of the proliferation of proteolytic microflora and restriction of the translocation of intestinal bacteria into the biliary and urinary systems.

Lactulose intake leads to excessive excretion of bile acids with feces and, as a result, to their increased formation in the liver from cholesterol.

The latter leads to a decrease in the cholesterol content in the blood and bile, which is desirable in cholelithiasis and hypercholesterolemia

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