Authors: Qing Liu,1 Zhong Ping Duan,1 Da Kang Ha,1 Stig Bengmark,2 Jelica Kurtovic,3 and Stephen M. Riordan3.
Published: HEPATOLOGY, May 2004;39:1441–1449.
The study was conducted in vivo, involving human participants.
Design: Randomized. Controlled.
Treatment: For 30 days. (Group A) received oral supplementation with a synbiotic preparation, (Group B) received the 4 fibers but not the lactic acid bacteria. (Group C) received a placebo..
Where and when:
Sample size: 97 patients.
Sample criteria: Patients with Hepatic Cirrhotic. Only patients who had been abstinent from alcohol for at least 2 months, as corroborated by family members and/or caregivers, were included. Patients with histological features of alcoholic hepatitis were excluded. If liver histology was not available, patients in whom the serum gamma-glutamyl transpeptidase level fell during a 2-month period of observation prior to study entry were excluded. The exclusion criteria also included a history within the previous 6 weeks of factors that may have influenced gut flora and circulating endotoxin and ammonia levels, including infection, treatment with antibiotics, lactulose or immunomodulatory drugs, and gastrointestinal hemorrhage.24 In addition to intercurrent infection and gastrointestinal hemorrhage, patients with other possible causes of reversible hepatic functional decompensation, such as drug-related hepatotoxicity and choledocholithiasis, were excluded. Patients with other known precipitants of HE, including renal impairment, electrolyte imbalance, and complicating hepatocellular carcinoma, were also excluded.
Analysed material: Fecal samples.
Results
Cirrhotic patients with MHE were found to have significant fecal overgrowth of E. coli and Staphylococcus spp. Group A (synbiotic preparation) had a significant reduction in viable counts of both of these overgrowth species, with viable counts falling to levels comparable to those in healthy controls. Supplementation with the placebo preparation was associated with no significant change in viable counts of any of the gut flora assessed. (s. 1444).
Improvement in the Child-Turcotte-Pugh classification on day 30 of supplementation compared to baseline was documented in a significantly greater proportion of Group A than Group C patients. (s. 1446).
Supplementation with the synbiotic preparation led to significant reductions in viable counts of E. coli and Staphylococcus spp, with reversal of overgrowth of these flora. A significant reduction in viable counts of Fusobacterium spp, potentially pathogenic anaerobic Gram-negative bacteria, was also documented.
Treatment led to a significant increase in viable counts of non-urease-producing Lactobacillus spp, with these species becoming the predominant of the measured organisms in feces.
The effects of synbiotic preparation on the gut flora were durable, with the significantly increased viable counts of Lactobabacillus spp and reduced counts of E. coli and Staphylococcus spp persisting at reassessment14 days after supplementation.
Blood ammonia levels were significantly lowered in the synbiotic-treated group compared to baseline, with the mean value reduced by 36%. (s. 1446).
MHE was reversed in 50% of patients treated with synbiotics, a response rate significantly higher than the 13% demonstrated in placebo-treated patients.
Treatment with fiber alone was also of benefit in cirrhotic patients with MHE. As with synbiotic-treated patients, the fecal pH was reduced in most cases. (s. 1447).
Indicative results
Treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis. (s. 1441).
Further studies are required to determine by which treatment with synbiotics and fermentable fiber alone significantly reduces inflammation and improves function in these patients (1448).
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