Despite advancements in the therapeutics of liver disease, portal-systemic encephalopathy is still challenging for clinicians because of the heterogeneity of neuropsychiatric symptoms, numerous risk factors, and the complexity of gaining a sustained response. The present study evaluated the efficacy of L-Ornithin, L-Aspartate contrasted with lactulose in Mexican patients with hyperammonemic hepatic encephalopathy. It randomized 20 patients to receive either lactulose or L-ornithine - L-aspartate for two weeks.

The study observed-

• Comparable age and degree of hepatic failure based on the Child-Pugh scale in patients of both groups at baseline. 
• A significant decrease in ammonia levels both in the lactulose group and in the LOLA group. 
• A significant improvement in mental status, Number Connection Test, asterixis, as well as EEG findings in patients who received LOLA. 
• Similar compliance with study medications between the lactulose group (94%) and the LOLA group (100%). 
• No serious adverse events in the two groups; however, an increase in the number of weekly defecations in the lactulose group, as well as a greater incidence of abdominal pain or flatulence. 
• An improvement in the Visual Analogue Scale for EuroQol index in patients of both groups. 

This study shows that the oral administration of lactulose or L-ornithine - L-aspartate to patients with cirrhosis and hyperammonemic encephalopathy significantly reduces serum ammonia levels, along with improving mental status parameters, number connection test, asterixis scores, and EEG activity.

Poo JL, Góngora J, Sánchez-Avila F, Aguilar-Castillo S, García-Ramos G, Fernández-Zertuche M, Rodríguez-Fragoso L, Uribe M. Efficacy of oral L-ornithine-L-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study. Ann Hepatol. 2006 Oct-Dec;5(4):281-8. PMID: 17151582.