Author information

¹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

²Dieta Health, Oak Park, California, USA.

³Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia.

Abstract

Background: Management of hepatic encephalopathy relies on self-titration of lactulose. In this feasibility trial, we assess an artificial intelligence-enabled tool, to guide lactulose use via a smartphone app.

Methods: Subjects with hepatic encephalopathy on lactulose captured bowel movement pictures during lead-in and intervention phases. During the intervention phase daily feedback on lactulose titration was delivered through the app. Goals were determined according to number of bowel movement and Bristol Stool Scale reports.

Results: Subjects completed the study with over 80% satisfaction. In the lead-in phase, less compliant subjects achieved Bristol Stool Scale goal on 62/111 (56%) of days compared to 107/136 (79%) in the intervention phase (p=0.041), while the most compliant subjects showed no difference. Severe/recurrent hepatic encephalopathy group achieved Bristol Stool Scale goal on 80/104 (77%) days in the lead-in and 90/110 (82%) days in the intervention phase(p=NS), compared to 89/143 (62%) days and 86/127 (68%) days in the stable group.

Conclusion: Dieta® app is a promising tool for objective Bowel Movement/ Bristol Stool Scale tracking for HE and may potentially be used to assist with lactulose titration.