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. 2014 Aug;19(8):703-8.

Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy

Ahmad Shavakhi  1 , Huriyeh Hashemi  1 , Elham Tabesh  1 , Zhaleh Derakhshan  1 , Somaye Farzamnia  1 , Shirin Meshkinfar  1 , Sara Shavakhi  2 , Mohammad Minakari  1 , Ali Gholamrezaei  2
Affiliations

Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy

Ahmad Shavakhi et al. J Res Med Sci. 2014 Aug.

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.

Keywords: Hepatic encephalopathy; lactulose; prebiotics; probiotics; synbiotics.

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Conflict of interest statement

Potential competing interests: None declared.

Figures

Figure 1
Figure 1
Study flowchart demonstrating patient flow throughout the study procedures
Figure 2
Figure 2
Trend of changes in psychometric hepatic encephalopathy scores from baseline to 10th week among the three groups. PHES, psychometric hepatic encephalopathy score
See this image and copyright information in PMC

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