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Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy.
Arab J Gastroenterol 2013; 14(3):116-22AJ

Abstract

BACKGROUND AND STUDY AIMS

Minimal hepatic encephalopathy (MHE) is diagnosed when hepatic patients perform worse on psychometric tests compared to healthy controls. This study aimed to evaluate probiotics as alternative therapy in MHE.

PATIENTS AND METHODS

This is an open-label randomised controlled trial, performed in the Department of Tropical Medicine and Infectious Diseases, Tanta University Hospitals, from March 2010 to January 2012. A total of 90 patients with MHE were allocated by simple randomisation to three parallel equal groups. Group A received lactulose, group B a probiotic (Lactobacillus acidophilus) and group C served as the control. After informed consent, patients were tested for gut micrecology, fasting blood ammonia, liver functions and magnetic resonance spectroscopy (MRS) examination to study brain metabolites, mainly choline (Cho), myo-inositol (mI), glutamine+glutamate (Glx) and creatinin (Cre). Patients who developed overt encephalopathy were excluded from analysis. The whole battery of investigations was repeated in the same order after 4weeks.

RESULTS

The probiotic was better tolerated than lactulose. The relative risk reduction (RRR) of developing overt encephalopathy was 60% in the case of lactulose and 80% in the case of probiotic, with a number needed to treat (NNT) of 2.4 and 2.3, respectively. The differential but not total microecology count was significantly shifted towards saccharolytic rather than proteolytic bacteria. The mI/Cre and (Cho+mI)/Glx ratios were significantly increased and the Glx/Cre ratio was significantly reduced after 1month-follow-up in the probiotic group compared to the lactulose group and in both treatment groups compared to the control group.

CONCLUSION

Both probiotic and lactulose therapy can improve blood ammonia and psychometric tests in MHE and reduce the risk of developing overt encephalopathy. MRS showed more improvement in the levels of brain neurometabolites in the probiotic group.

Authors+Show Affiliations

Tropical Medicine and Infectious Disease Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbia, Egypt. Electronic address: dhz646@hotmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24206740

Citation

Ziada, Dina H., et al. "Can Lactobacillus Acidophilus Improve Minimal Hepatic Encephalopathy? a Neurometabolite Study Using Magnetic Resonance Spectroscopy." Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology, vol. 14, no. 3, 2013, pp. 116-22.
Ziada DH, Soliman HH, El Yamany SA, et al. Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy. Arab J Gastroenterol. 2013;14(3):116-22.
Ziada, D. H., Soliman, H. H., El Yamany, S. A., Hamisa, M. F., & Hasan, A. M. (2013). Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy. Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology, 14(3), pp. 116-22. doi:10.1016/j.ajg.2013.08.002.
Ziada DH, et al. Can Lactobacillus Acidophilus Improve Minimal Hepatic Encephalopathy? a Neurometabolite Study Using Magnetic Resonance Spectroscopy. Arab J Gastroenterol. 2013;14(3):116-22. PubMed PMID: 24206740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy. AU - Ziada,Dina H, AU - Soliman,Hanan H, AU - El Yamany,Saher A, AU - Hamisa,Manal F, AU - Hasan,Azza M, Y1 - 2013/09/23/ PY - 2012/10/03/received PY - 2013/08/20/accepted PY - 2013/11/12/entrez PY - 2013/11/12/pubmed PY - 2014/10/31/medline KW - ANOVA KW - ARR KW - BDT KW - Cho KW - Cre KW - Creatinine KW - DST KW - Glx KW - HE KW - HRQOL KW - LTT KW - Lactobacillus acidophilus KW - MHE KW - MRS KW - Magnetic resonance spectroscopy (MRS) KW - Minimal hepatic encephalopathy (MHE) KW - NCT-A KW - NCT-B KW - NNT KW - RRR KW - SDT KW - absolute risk reduction KW - block design test KW - choline KW - digit symbol test KW - glutamine–glutamate KW - health-related quality of life KW - hepatic encephalopathy KW - line tracing test KW - mI KW - magnetic resonance spectroscopy KW - minimal hepatic encephalopathy KW - myo-inositol KW - number connection test-A KW - number connection test-B KW - number needed to treat KW - one-way analysis of variance KW - relative risk reduction KW - serial-dotting test SP - 116 EP - 22 JF - Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology JO - Arab J Gastroenterol VL - 14 IS - 3 N2 - BACKGROUND AND STUDY AIMS: Minimal hepatic encephalopathy (MHE) is diagnosed when hepatic patients perform worse on psychometric tests compared to healthy controls. This study aimed to evaluate probiotics as alternative therapy in MHE. PATIENTS AND METHODS: This is an open-label randomised controlled trial, performed in the Department of Tropical Medicine and Infectious Diseases, Tanta University Hospitals, from March 2010 to January 2012. A total of 90 patients with MHE were allocated by simple randomisation to three parallel equal groups. Group A received lactulose, group B a probiotic (Lactobacillus acidophilus) and group C served as the control. After informed consent, patients were tested for gut micrecology, fasting blood ammonia, liver functions and magnetic resonance spectroscopy (MRS) examination to study brain metabolites, mainly choline (Cho), myo-inositol (mI), glutamine+glutamate (Glx) and creatinin (Cre). Patients who developed overt encephalopathy were excluded from analysis. The whole battery of investigations was repeated in the same order after 4weeks. RESULTS: The probiotic was better tolerated than lactulose. The relative risk reduction (RRR) of developing overt encephalopathy was 60% in the case of lactulose and 80% in the case of probiotic, with a number needed to treat (NNT) of 2.4 and 2.3, respectively. The differential but not total microecology count was significantly shifted towards saccharolytic rather than proteolytic bacteria. The mI/Cre and (Cho+mI)/Glx ratios were significantly increased and the Glx/Cre ratio was significantly reduced after 1month-follow-up in the probiotic group compared to the lactulose group and in both treatment groups compared to the control group. CONCLUSION: Both probiotic and lactulose therapy can improve blood ammonia and psychometric tests in MHE and reduce the risk of developing overt encephalopathy. MRS showed more improvement in the levels of brain neurometabolites in the probiotic group. SN - 2090-2387 UR - https://www.unboundmedicine.com/medline/citation/24206740/Can_Lactobacillus_acidophilus_improve_minimal_hepatic_encephalopathy_A_neurometabolite_study_using_magnetic_resonance_spectroscopy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1687-1979(13)00119-6 DB - PRIME DP - Unbound Medicine ER -