Preventing Falls in Cirrhosis: Lactulose + TeleTai-Chi in LiveSMART Trial: Hepatology | September 2026

What Did the Study Find?

The peer-reviewed LiveSMART trial evaluated lactulose and TeleTai-Chi in patients with cirrhosis and portal hypertension without previous overt hepatic encephalopathy (HE).

Lactulose followed by TeleTai-Chi reduced injurious falls to 4% vs 12% with enhanced usual care.

Non-injurious falls were also reduced: 19% vs 32%.

The sequential strategy significantly improved the trial’s hierarchical composite outcome.

Analyses also supported benefit from the individual interventions, particularly lactulose.

Importantly, the population had no previous overt HE, extending the concept beyond conventional secondary HE prevention.

The final publication confirms previously presented late-breaking trial findings.

Why Does It Matter?

Falls are common, disabling and under-recognised complications of cirrhosis. LiveSMART suggests they may be modifiable through combined neurocognitive and physical-function interventions.

GastroAGI Takeaway

Falls should become an active target in cirrhosis care, not simply an inevitable complication. LiveSMART provides randomised evidence that lactulose plus structured balance/strength training can reduce falls even before overt HE develops. However, routine lactulose solely for fall prevention is not yet guideline-standard practice.