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Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials.
Liver Int. 2016 07; 36(7):986-93.LI

Abstract

BACKGROUND

Hepatic encephalopathy (HE) is a major complication of cirrhosis and is associated with decreased survival and increased health care utilization.

AIM

The aim of this study was to evaluate the efficacy of probiotics in the management minimal hepatic encephalopathy HE (MHE) and overt HE (OHE) in comparison to no treatment/placebo and lactulose.

METHODS

The main outcomes measured were mortality, improvement in MHE, progression to OHE in patients with MHE and hospitalization. We calculated odds ratios (OR) with 95% confidence intervals (CI). Study heterogeneity was assessed using the I(2) statistic.

RESULTS

Fourteen studies totalling 1152 patients were included in the analysis. The use of probiotics had no impact on the overall mortality when compared to either lactulose (OR: 1.07, 95% CI: 0.47-2.44, P = 0.88) or no treatment/placebo (OR: 0.69, 95% CI: 0.42-1.14, P = 0.15). When probiotics was compared to no treatment/placebo, it was associated with a significant improvement in MHE (OR: 3.91, 95% CI: 2.25-6.80, P < 0.00001), decreased hospitalization rates (OR: 0.53, 95% CI: 0.33-0.86, P = 0.01) and decreased progression to overt hepatic encephalopathy (OR: 0.40, 95% CI: 0.26-0.60, P < 0.0001). However when compared to lactulose, probiotics did not show a significant difference in improvement of MHE (OR: 0.81, 95% CI: 0.52-1.27, P = 0.35), hospitalization rates (OR: 1.02, 95% CI: 0.52-1.99, P = 0.96) or progression to overt hepatic encephalopathy (OR: 1.24, 95% CI 0.73-2.10, P = 0.42).

CONCLUSIONS

Overall the use of probiotics was more effective in decreasing hospitalization rates, improving MHE and preventing progression to OHE in patients with underlying MHE than placebo, but similar to that seen with lactulose. The use of probiotics did not affect mortality rates.

Authors+Show Affiliations

Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA. Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.Department of Medicine, Olive View Medical Center, Sylmar, CA, USA.Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA. Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. Liver Center, Huntington Medical Research Institutes, Pasadena, CA, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

26561214

Citation

Saab, Sammy, et al. "Probiotics Are Helpful in Hepatic Encephalopathy: a Meta-analysis of Randomized Trials." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 36, no. 7, 2016, pp. 986-93.
Saab S, Suraweera D, Au J, et al. Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials. Liver Int. 2016;36(7):986-93.
Saab, S., Suraweera, D., Au, J., Saab, E. G., Alper, T. S., & Tong, M. J. (2016). Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials. Liver International : Official Journal of the International Association for the Study of the Liver, 36(7), 986-93. https://doi.org/10.1111/liv.13005
Saab S, et al. Probiotics Are Helpful in Hepatic Encephalopathy: a Meta-analysis of Randomized Trials. Liver Int. 2016;36(7):986-93. PubMed PMID: 26561214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials. AU - Saab,Sammy, AU - Suraweera,Duminda, AU - Au,Jennifer, AU - Saab,Elena G, AU - Alper,Tori S, AU - Tong,Myron J, Y1 - 2015/12/17/ PY - 2015/09/16/received PY - 2015/11/02/accepted PY - 2015/11/13/entrez PY - 2015/11/13/pubmed PY - 2017/11/29/medline KW - cirrhosis KW - hepatic encephalopathy KW - probiotics SP - 986 EP - 93 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int. VL - 36 IS - 7 N2 - BACKGROUND: Hepatic encephalopathy (HE) is a major complication of cirrhosis and is associated with decreased survival and increased health care utilization. AIM: The aim of this study was to evaluate the efficacy of probiotics in the management minimal hepatic encephalopathy HE (MHE) and overt HE (OHE) in comparison to no treatment/placebo and lactulose. METHODS: The main outcomes measured were mortality, improvement in MHE, progression to OHE in patients with MHE and hospitalization. We calculated odds ratios (OR) with 95% confidence intervals (CI). Study heterogeneity was assessed using the I(2) statistic. RESULTS: Fourteen studies totalling 1152 patients were included in the analysis. The use of probiotics had no impact on the overall mortality when compared to either lactulose (OR: 1.07, 95% CI: 0.47-2.44, P = 0.88) or no treatment/placebo (OR: 0.69, 95% CI: 0.42-1.14, P = 0.15). When probiotics was compared to no treatment/placebo, it was associated with a significant improvement in MHE (OR: 3.91, 95% CI: 2.25-6.80, P < 0.00001), decreased hospitalization rates (OR: 0.53, 95% CI: 0.33-0.86, P = 0.01) and decreased progression to overt hepatic encephalopathy (OR: 0.40, 95% CI: 0.26-0.60, P < 0.0001). However when compared to lactulose, probiotics did not show a significant difference in improvement of MHE (OR: 0.81, 95% CI: 0.52-1.27, P = 0.35), hospitalization rates (OR: 1.02, 95% CI: 0.52-1.99, P = 0.96) or progression to overt hepatic encephalopathy (OR: 1.24, 95% CI 0.73-2.10, P = 0.42). CONCLUSIONS: Overall the use of probiotics was more effective in decreasing hospitalization rates, improving MHE and preventing progression to OHE in patients with underlying MHE than placebo, but similar to that seen with lactulose. The use of probiotics did not affect mortality rates. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/26561214/Probiotics_are_helpful_in_hepatic_encephalopathy:_a_meta_analysis_of_randomized_trials_ L2 - https://doi.org/10.1111/liv.13005 DB - PRIME DP - Unbound Medicine ER -