Hepatic encephalopathy is associated with a poor prognosis in patients with advanced liver disease. Probiotics alter the intestinal microbiota with non–urease-producing organisms that reduce production of ammonia.
Dr Barjesh Chander Sharma and colleagues from India investigated the efficacy of probiotics for the primary prophylaxis of hepatic encephalopathy.
The research team conducted a prospective trial at a tertiary care referral institute in New Delhi, India, from 2012 through 2013, of patients with cirrhosis without overt hepatic encephalopathy.
Subjects were assigned randomly to groups given probiotics or no test article.
All subjects underwent psychometric analyses, critical flicker fusion threshold assessments, glucose hydrogen breath tests to identify small intestinal bacterial overgrowth, and lactulose hydrogen breath tests to measure orocecal transit time.
|Probiotic administration increased psychometric hepatic encephalopathy scores|
|Clinical Gastroenterology & Hepatology|
The team's primary end point was the development of overt hepatic encephalopathy.
At baseline, subjects in each group had comparable CTP score, model for end-stage liver disease scores, critical flicker fusion assessments, psychometric hepatic encephalopathy scores, and orocecal transit time.
The team found that after a mean follow-up period of 39 weeks for patients given probiotics and 40 weeks for controls, 6 patients given probiotics and 7 controls died.
The research team observed that 3 months of probiotic administration significantly reduced levels of arterial ammonia, small intestinal bacterial overgrowth, and orocecal transit time.
The team also found that probiotic administration increased psychometric hepatic encephalopathy scores, and increased critical flicker fusion thresholds, compared with baseline.
The researchers noted that 7 subjects in the probiotic group and 14 controls developed overt hepatic encephalopathy.
Psychometric hepatic encephalopathy scores, CTP scores, and small intestinal bacterial overgrowth correlated with the development of overt hepatic encephalopathy.
Dr Sharma and team comment, "In a prospective, randomized controlled trial, probiotics were found to be effective in preventing hepatic encephalopathy in patients with cirrhosis."