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Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy.
J Res Med Sci. 2014 Aug; 19(8):703-8.JR

Abstract

BACKGROUND

Some evidence has shown benefits of probiotics in the management of minimal hepatic encephalopathy (MHE). We evaluated the efficacy of a multistrain probiotic compound, alone and in combination with lactulose, in the treatment of MHE.

MATERIALS AND METHODS

This study has two parts. First, consecutive adult patients with MHE were randomized to receive lactulose (30-60 mL/day) + probiotic (200 million colony forming units of seven bacteria species/day) (Gp-LPr) or lactulose + placebo (Gp-L). In second part, a non-randomized group of patients received probiotic alone (Gp-Pr). Medication duration was for 2 weeks and patients were followed-up for another 8 weeks. Improvement in MHE status was assessed by psychometric hepatic encephalopathy score (PHES). Development of overt encephalopathy, hospitalization, and death were considered as secondary outcomes.

RESULTS

Sixty patients (80% male, mean age 38.4 ± 9.6 years) completed the intervention. PHES significantly improved after medication in all the three groups (Gp-LPr: -3.8 ± 3.9 to -1.6 ± 3.0; Gp-L: -4.8 ± 4.1 to -1.6 ± 2.9; and Gp-Pr: -4.9 ± 3.7 to -2.1 ± 2.5, P < 0.001). After 8 weeks follow-up, improvement was maintained in Gp-LPr and Gp-Pr, but there was deterioration in those who did not receive probiotics (Gp-L: PHES score reversed to -4.8 ± 4.2). Two patients (one each in Gp-L and Gp-Pr) experienced overt encephalopathy. One patient was hospitalized due to worsening of ascites (Gp-LPr) and one due to spontaneous bacterial peritonitis (Gp-L). Side effects were mild and not significantly different among the groups.

CONCLUSION

Lactulose and probiotics are effective for the treatment of MHE; however, probiotics, but not lactulose, have long-term effects. More studies are required before suggesting probiotics for the standard treatment of MHE.

Authors+Show Affiliations

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25422653

Citation

Shavakhi, Ahmad, et al. "Multistrain Probiotic and Lactulose in the Treatment of Minimal Hepatic Encephalopathy." Journal of Research in Medical Sciences : the Official Journal of Isfahan University of Medical Sciences, vol. 19, no. 8, 2014, pp. 703-8.
Shavakhi A, Hashemi H, Tabesh E, et al. Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy. J Res Med Sci. 2014;19(8):703-8.
Shavakhi, A., Hashemi, H., Tabesh, E., Derakhshan, Z., Farzamnia, S., Meshkinfar, S., Shavakhi, S., Minakari, M., & Gholamrezaei, A. (2014). Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy. Journal of Research in Medical Sciences : the Official Journal of Isfahan University of Medical Sciences, 19(8), 703-8.
Shavakhi A, et al. Multistrain Probiotic and Lactulose in the Treatment of Minimal Hepatic Encephalopathy. J Res Med Sci. 2014;19(8):703-8. PubMed PMID: 25422653.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy. AU - Shavakhi,Ahmad, AU - Hashemi,Huriyeh, AU - Tabesh,Elham, AU - Derakhshan,Zhaleh, AU - Farzamnia,Somaye, AU - Meshkinfar,Shirin, AU - Shavakhi,Sara, AU - Minakari,Mohammad, AU - Gholamrezaei,Ali, PY - 2013/03/11/received PY - 2013/05/19/revised PY - 2013/06/02/accepted PY - 2014/11/26/entrez PY - 2014/11/26/pubmed PY - 2014/11/26/medline KW - Hepatic encephalopathy KW - lactulose KW - prebiotics KW - probiotics KW - synbiotics SP - 703 EP - 8 JF - Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences JO - J Res Med Sci VL - 19 IS - 8 N2 - BACKGROUND: Some evidence has shown benefits of probiotics in the management of minimal hepatic encephalopathy (MHE). We evaluated the efficacy of a multistrain probiotic compound, alone and in combination with lactulose, in the treatment of MHE. MATERIALS AND METHODS: This study has two parts. First, consecutive adult patients with MHE were randomized to receive lactulose (30-60 mL/day) + probiotic (200 million colony forming units of seven bacteria species/day) (Gp-LPr) or lactulose + placebo (Gp-L). In second part, a non-randomized group of patients received probiotic alone (Gp-Pr). Medication duration was for 2 weeks and patients were followed-up for another 8 weeks. Improvement in MHE status was assessed by psychometric hepatic encephalopathy score (PHES). Development of overt encephalopathy, hospitalization, and death were considered as secondary outcomes. RESULTS: Sixty patients (80% male, mean age 38.4 ± 9.6 years) completed the intervention. PHES significantly improved after medication in all the three groups (Gp-LPr: -3.8 ± 3.9 to -1.6 ± 3.0; Gp-L: -4.8 ± 4.1 to -1.6 ± 2.9; and Gp-Pr: -4.9 ± 3.7 to -2.1 ± 2.5, P < 0.001). After 8 weeks follow-up, improvement was maintained in Gp-LPr and Gp-Pr, but there was deterioration in those who did not receive probiotics (Gp-L: PHES score reversed to -4.8 ± 4.2). Two patients (one each in Gp-L and Gp-Pr) experienced overt encephalopathy. One patient was hospitalized due to worsening of ascites (Gp-LPr) and one due to spontaneous bacterial peritonitis (Gp-L). Side effects were mild and not significantly different among the groups. CONCLUSION: Lactulose and probiotics are effective for the treatment of MHE; however, probiotics, but not lactulose, have long-term effects. More studies are required before suggesting probiotics for the standard treatment of MHE. SN - 1735-1995 UR - https://www.unboundmedicine.com/medline/citation/25422653/Multistrain_probiotic_and_lactulose_in_the_treatment_of_minimal_hepatic_encephalopathy_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25422653/ DB - PRIME DP - Unbound Medicine ER -