***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a double-blind , r and omized study the efficacy of lactulose was compared with neomycin-sorbitol in 45 episodes of acute nitrogenous portal-systemic encephalopathy ( PSE ) induced by dietary protein , azotemia , or gastrointestinal hemorrhage . All patients had underlying cirrhosis , and at the time of r and omization had encephalopathy of at least grade 2 severity and arterial ammonia concentrations greater than 150 μg/100 ml . Two thirds of the patients in each group returned to normal mental status and more than 80 % in each group showed at least one grade improvement in mental state . In addition , there was equivalent improvement in asterixis , in the performance of the Number Connection Test , in the electroencephalographic pattern , and in arterial ammonia concentration . The principal difference between the two groups was a greater reduction in stool pH after lactulose therapy than after neomycin-sorbitol therapy . One patient r and omized to neomycin-sorbitol had to be withdrawn from the study because of persistent vomiting related to the administration of the medication . Otherwise there were no complications attributable to therapy in either group . These data suggest that neomycin-sorbitol and lactulose are equally effective in the treatment of acute nitrogenous portal-systemic encephalopathy A r and omized double blind clinical comparison of neomycin and lactulose was performed in 33 cirrhotic patients with chronic portal-systemic encephalopathy ( PSE ) at seven cooperating hospitals . In order to maintain double blindness , sorbitol syrup was used as a control solution along with neomycin and was compared with lactulose syrup and placebo tablets in a double drug protocol . Twenty-nine patients were studied in a crossover investigation in which each received both therapeutic regimens preceded and followed by control periods . Four additional patients received one or the other agent , but did not receive both . Serial , semiquantitative assessment s were made in all patients of mental status , asterixis , and the trailmaking test ( TMT ) and electroencephalograms ( EEG ) and arterial ammonia levels . Both neomycin-sorbitol and lactulose were effective in the majority of patients ( 83 and 90 % , respectively ) . Each of these parameters ( mental state , asterixis , TMT , EEG , and NH3 ) was improved significantly by neomycin-sorbitol and lactulose . The post-treatment levels for each of these measures were similar in the neomycin and lactulose-treated groups . Mean stool pH was reduced by neomycinsorbitol to 6.1 and by lactulose to 5.5 . This difference was highly significant statistically . Bowel activity was similar in the two groups . Both drugs were free of toxicity . These investigations demonstrate that both lactulose and neomycin-sorbitol are effective in the treatment of chronic portal-systemic encephalopathy Hepatic encephalopathy due to cirrhosis is frequently precipitated by exogenous factors , and the effectiveness of a specific treatment with neomycin sulfate has so far not been su bmi tted to clinical trials . Over a period of five years , 102 cirrhotic patients developed hepatic encephalopathy at admission or during hospitalization , and 39 were r and omized for treatment with either neomycin sulfate or placebo .  Exclusion criteria were : 1 . current usage of specific treatment for hepatic encephalopathy , 2 . chronic hepatic encephalopathy and 3 . multiple organ failure syndrome associated with hepatic encephalopathy . The group of excluded patients ( n = 63 ) was compared with the r and omized group ( n = 39 ) , and no statistical differences were found regarding sex and age distributions , Child-Pugh classification , etiology of cirrhosis , percipitating factors and grade of hepatic encephalopathy . These same parameters were also comparable among the 20 patients who received active neomycin and the 19 who were treated with placebo . The therapy for hepatic encephalopathy consisted in the control of precipitating factors associated with 6 g of neomycin sulfate " per os " or placebo .  Therapeutic failure and death by the fifth day of treatment , occurred in four patients ( 10.2 % ) , two in each of the r and omized groups . The time elapsed between the initiation of the therapeutic procedure and regression to grade zero of hepatic encephalopathy was 39.11 + /- 23.04 hours for the group of active neomycin , and 49.47 + /- 21.92 hours for the placebo group , but this difference did not achieve statistical significance In a double blind clinical trial , 11 patients with HE received 80 g of lactulose ( 1,4-β-galactosidofructose ) daily while 10 patients received 60 g of glucose daily as a control . Encephalopathy and blood ammonia were evaluated during the study . Patients receiving lactulose showed statistically significant reduction in both encephalopathy and blood ammonia levels over the 10-day period as compared to the control patients . Controlled clinical trials comparing lactulose and Neomycin are needed 
    Output:
    
There is insufficient evidence to support or refute the use of non-absorbable disaccharides for hepatic encephalopathy .
Antibiotics were superior to non-absorbable disaccharides in improving hepatic encephalopathy , but it is unclear whether this difference is clinical ly important .