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Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis.
Hepatology 2004; 39(5):1441-9Hep

Abstract

Minimal hepatic encephalopathy (MHE) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis. Treatment with lactulose is of benefit. The possible role of synbiotics (probiotics and fermentable fiber) has not been assessed. We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials. MHE, defined by abnormality on at least one test modality, was present in 58 (60%) patients. Fifty-five of these patients with MHE were randomized to receive a synbiotic preparation (n = 20), fermentable fiber alone (n = 20), or placebo (n = 15) for 30 days. Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology, with significant fecal overgrowth of potentially pathogenic Escherichia coli and Staphylococcal species. Synbiotic treatment significantly increased the fecal content of non-urease-producing Lactobacillus species at the expense of these other bacterial species. Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50% of patients. Synbiotic treatment was also associated with a significant reduction in endotoxemia. The Child-Turcotte-Pugh functional class improved in nearly 50% of cases. Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients. In conclusion, treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis.

Authors+Show Affiliations

Artificial Liver Treatment and Training Center, Beijing Youan Hospital and Capital University of Medical Sciences, Beijing, China.

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15122774

Citation

Liu, Qing, et al. "Synbiotic Modulation of Gut Flora: Effect On Minimal Hepatic Encephalopathy in Patients With Cirrhosis." Hepatology (Baltimore, Md.), vol. 39, no. 5, 2004, pp. 1441-9.
Liu Q, Duan ZP, Ha DK, et al. Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology. 2004;39(5):1441-9.
Liu, Q., Duan, Z. P., Ha, D. K., Bengmark, S., Kurtovic, J., & Riordan, S. M. (2004). Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology (Baltimore, Md.), 39(5), pp. 1441-9.
Liu Q, et al. Synbiotic Modulation of Gut Flora: Effect On Minimal Hepatic Encephalopathy in Patients With Cirrhosis. Hepatology. 2004;39(5):1441-9. PubMed PMID: 15122774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. AU - Liu,Qing, AU - Duan,Zhong Ping, AU - Ha,Da Kang, AU - Bengmark,Stig, AU - Kurtovic,Jelica, AU - Riordan,Stephen M, PY - 2004/5/4/pubmed PY - 2004/5/25/medline PY - 2004/5/4/entrez SP - 1441 EP - 9 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 39 IS - 5 N2 - Minimal hepatic encephalopathy (MHE) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis. Treatment with lactulose is of benefit. The possible role of synbiotics (probiotics and fermentable fiber) has not been assessed. We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials. MHE, defined by abnormality on at least one test modality, was present in 58 (60%) patients. Fifty-five of these patients with MHE were randomized to receive a synbiotic preparation (n = 20), fermentable fiber alone (n = 20), or placebo (n = 15) for 30 days. Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology, with significant fecal overgrowth of potentially pathogenic Escherichia coli and Staphylococcal species. Synbiotic treatment significantly increased the fecal content of non-urease-producing Lactobacillus species at the expense of these other bacterial species. Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50% of patients. Synbiotic treatment was also associated with a significant reduction in endotoxemia. The Child-Turcotte-Pugh functional class improved in nearly 50% of cases. Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients. In conclusion, treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/15122774/Synbiotic_modulation_of_gut_flora:_effect_on_minimal_hepatic_encephalopathy_in_patients_with_cirrhosis_ L2 - https://doi.org/10.1002/hep.20194 DB - PRIME DP - Unbound Medicine ER -