The changes that occurred in the faecal flora during the separate administration of lactulose and magnesium sulphate were studied in five patients with hepatic encephalopathy. Lactulose therapy produced significant increases in lactobacillus counts in three patients, and two of these patients showed clinical improvement. No systematic change occurred in the counts of other organisms during either treatment; in particular it was not possible to correlate clinical improvement with a reduction in the count of the two groups of organisms-enterobacteria and Bacteroides spp.-that are considered to be most active in the production of ammonia.
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