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Probiotic yogurt for the treatment of minimal hepatic encephalopathy.

Abstract

OBJECTIVES

Minimal hepatic encephalopathy (MHE), the preclinical stage of overt hepatic encephalopathy (OHE), is a significant condition affecting up to 60% of cirrhotics. All MHE therapies modify gut microflora, but consensus regarding MHE treatment and long-term adherence studies is lacking. The aim was to determine the effect of probiotic supplementation in the form of a food item, probiotic yogurt, on MHE reversal and adherence.

METHODS

Nonalcoholic MHE cirrhotics (defined by a standard psychometric battery) were randomized with unblinded allocation to receive probiotic yogurt (with proven culture stability) or no treatment (no Rx) for 60 days in a 2:1 ratio. Quality of life (short form [SF]-36), adherence, venous ammonia, model of end-stage liver disease (MELD) scores, and inflammatory markers (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6) were also measured. Outcomes were MHE reversal using blinded scoring, OHE development, and adherence.

RESULTS

Twenty-five patients (17 yogurt, 8 no Rx; 84% Child class A) were enrolled. A significantly higher percentage of yogurt patients reversed MHE compared to no Rx patients (71%vs 0%, P= 0.003, intention-to-treat). Yogurt patients demonstrated a significant improvement in number connection test-A (NCT-A), block design test (BDT), and digit symbol test (DST) compared to baseline/no Rx group. Twenty-five percent of no Rx versus 0% of yogurt patients developed OHE during the trial. Eighty-eight percent of yogurt patients were adherent. No adverse effects or change in covariates were observed. All patients who completed the yogurt arm were agreeable to continue yogurt for 6 months if needed.

CONCLUSIONS

This trial demonstrated a significant rate of MHE reversal and excellent adherence in cirrhotics after probiotic yogurt supplementation with potential for long-term adherence.

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  • Authors+Show Affiliations

    ,

    Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA.

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    Source

    MeSH

    Ammonia
    Hepatic Encephalopathy
    Humans
    Interleukin-6
    Middle Aged
    Patient Compliance
    Probiotics
    Quality of Life
    Tumor Necrosis Factor-alpha
    Veins
    Yogurt

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    18691193

    Citation

    Bajaj, Jasmohan S., et al. "Probiotic Yogurt for the Treatment of Minimal Hepatic Encephalopathy." The American Journal of Gastroenterology, vol. 103, no. 7, 2008, pp. 1707-15.
    Bajaj JS, Saeian K, Christensen KM, et al. Probiotic yogurt for the treatment of minimal hepatic encephalopathy. Am J Gastroenterol. 2008;103(7):1707-15.
    Bajaj, J. S., Saeian, K., Christensen, K. M., Hafeezullah, M., Varma, R. R., Franco, J., ... Binion, D. G. (2008). Probiotic yogurt for the treatment of minimal hepatic encephalopathy. The American Journal of Gastroenterology, 103(7), pp. 1707-15. doi:10.1111/j.1572-0241.2008.01861.x.
    Bajaj JS, et al. Probiotic Yogurt for the Treatment of Minimal Hepatic Encephalopathy. Am J Gastroenterol. 2008;103(7):1707-15. PubMed PMID: 18691193.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Probiotic yogurt for the treatment of minimal hepatic encephalopathy. AU - Bajaj,Jasmohan S, AU - Saeian,Kia, AU - Christensen,Kenneth M, AU - Hafeezullah,Muhammad, AU - Varma,Rajiv R, AU - Franco,Jose, AU - Pleuss,Joan A, AU - Krakower,Glenn, AU - Hoffmann,Raymond G, AU - Binion,David G, PY - 2008/8/12/pubmed PY - 2008/9/4/medline PY - 2008/8/12/entrez SP - 1707 EP - 15 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 103 IS - 7 N2 - OBJECTIVES: Minimal hepatic encephalopathy (MHE), the preclinical stage of overt hepatic encephalopathy (OHE), is a significant condition affecting up to 60% of cirrhotics. All MHE therapies modify gut microflora, but consensus regarding MHE treatment and long-term adherence studies is lacking. The aim was to determine the effect of probiotic supplementation in the form of a food item, probiotic yogurt, on MHE reversal and adherence. METHODS: Nonalcoholic MHE cirrhotics (defined by a standard psychometric battery) were randomized with unblinded allocation to receive probiotic yogurt (with proven culture stability) or no treatment (no Rx) for 60 days in a 2:1 ratio. Quality of life (short form [SF]-36), adherence, venous ammonia, model of end-stage liver disease (MELD) scores, and inflammatory markers (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6) were also measured. Outcomes were MHE reversal using blinded scoring, OHE development, and adherence. RESULTS: Twenty-five patients (17 yogurt, 8 no Rx; 84% Child class A) were enrolled. A significantly higher percentage of yogurt patients reversed MHE compared to no Rx patients (71%vs 0%, P= 0.003, intention-to-treat). Yogurt patients demonstrated a significant improvement in number connection test-A (NCT-A), block design test (BDT), and digit symbol test (DST) compared to baseline/no Rx group. Twenty-five percent of no Rx versus 0% of yogurt patients developed OHE during the trial. Eighty-eight percent of yogurt patients were adherent. No adverse effects or change in covariates were observed. All patients who completed the yogurt arm were agreeable to continue yogurt for 6 months if needed. CONCLUSIONS: This trial demonstrated a significant rate of MHE reversal and excellent adherence in cirrhotics after probiotic yogurt supplementation with potential for long-term adherence. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/18691193/Probiotic_yogurt_for_the_treatment_of_minimal_hepatic_encephalopathy_ L2 - http://Insights.ovid.com/pubmed?pmid=18691193 DB - PRIME DP - Unbound Medicine ER -