Tags

Type your tag names separated by a space and hit enter

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy.
Aliment Pharmacol Ther. 2011 Mar; 33(6):662-71.AP

Abstract

BACKGROUND

Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE.

AIM

To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials.

METHODS

MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association.

RESULTS

Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32-0.50; P<0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24-0.47; P<0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26-0.65; P<0.0001 and RR of 0.51, 95% CI 0.32-0.80; P=0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose.

CONCLUSIONS

The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics.

Authors+Show Affiliations

Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

21251030

Citation

Shukla, S, et al. "Meta-analysis: the Effects of Gut Flora Modulation Using Prebiotics, Probiotics and Synbiotics On Minimal Hepatic Encephalopathy." Alimentary Pharmacology & Therapeutics, vol. 33, no. 6, 2011, pp. 662-71.
Shukla S, Shukla A, Mehboob S, et al. Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. Aliment Pharmacol Ther. 2011;33(6):662-71.
Shukla, S., Shukla, A., Mehboob, S., & Guha, S. (2011). Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. Alimentary Pharmacology & Therapeutics, 33(6), 662-71. https://doi.org/10.1111/j.1365-2036.2010.04574.x
Shukla S, et al. Meta-analysis: the Effects of Gut Flora Modulation Using Prebiotics, Probiotics and Synbiotics On Minimal Hepatic Encephalopathy. Aliment Pharmacol Ther. 2011;33(6):662-71. PubMed PMID: 21251030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. AU - Shukla,S, AU - Shukla,A, AU - Mehboob,S, AU - Guha,S, Y1 - 2011/01/20/ PY - 2011/1/22/entrez PY - 2011/1/22/pubmed PY - 2011/6/4/medline SP - 662 EP - 71 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 33 IS - 6 N2 - BACKGROUND: Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE. AIM: To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials. METHODS: MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association. RESULTS: Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32-0.50; P<0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24-0.47; P<0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26-0.65; P<0.0001 and RR of 0.51, 95% CI 0.32-0.80; P=0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose. CONCLUSIONS: The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/21251030/Meta_analysis:_the_effects_of_gut_flora_modulation_using_prebiotics_probiotics_and_synbiotics_on_minimal_hepatic_encephalopathy_ L2 - https://doi.org/10.1111/j.1365-2036.2010.04574.x DB - PRIME DP - Unbound Medicine ER -