Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug 30;17(8):e0273231.
doi: 10.1371/journal.pone.0273231. eCollection 2022.

Antibiotics and probiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and a meta-analysis

Haonan Zhang  1 , Jian Gao  2
Affiliations
Meta-Analysis

Antibiotics and probiotics on hepatic venous pressure gradient in cirrhosis: A systematic review and a meta-analysis

Haonan Zhang et al. PLoS One. .

Abstract

Background: Modulation of the gut microbiome could favorably alter the hepatic venous pressure gradient (HVPG) in cirrhosis and portal hypertension (PH).

Aim: This meta-analysis was to evaluate the effects of microbiome-targeted therapies (MTTs) on HVPG in persons with cirrhosis and PH.

Methods: PubMed, The Cochrane Library, Embase, Web of Science and Scopus were searched for randomized clinical trials (RCTs) analyzing the effects on HVPG in people with cirrhosis who received MTTs. Clinical outcomes were pooled using RevMan5.3 software. A trial sequential analysis was applied to calculate the required information size and evaluate the credibility of the meta-analysis results.

Results: A total of six studies were included. MTTs were associated with a reduction of 1.22 mm Hg in HVPG (95% CI: -2.31, -0.14 mmHg, P = 0.03). Subgroup analysis showed a greater reduction with longer duration (-1.88 mmHg;95% CI: -3.23, -0.53; P = 0.006). In the trial sequential analysis of HVPG reduction, the cumulative Z curve crossed the traditional significance boundary without the achievement of required information size (330).

Conclusions: MTTs may be associated with a reduction in HVPG in patients with cirrhosis and PH. Microbiome-targeted therapies merit additional large-sample studies to define the efficacy of HVPG.

Systematic review registration: PROSPERO 2020: CRD4202021609.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the screening process.
Fig 2
Fig 2. Quality assessment of RCTs for risk of bias.
Fig 3
Fig 3. Forest plot of MTT on HVPG reduction in cirrhosis patients.
Fig 4
Fig 4. Forest plot of antibiotics and probiotics on HVPG reduction in cirrhosis patients.
Fig 5
Fig 5. Forest plot according to duration of MTT on HVPG reduction in cirrhosis patients.
Fig 6
Fig 6. Forest plot of MTT on LBP, TNF-α, IL-6 and NO.
Fig 7
Fig 7. Trial sequential analysis.
See this image and copyright information in PMC

References

    1. Simonetto DA, Liu M, Kamath PS. Portal Hypertension and Related Complications: Diagnosis and Management. Mayo Clin Proc 2019; 94:714–726. doi: 10.1016/j.mayocp.2018.12.020 - DOI - PubMed
    1. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65:310–335. doi: 10.1002/hep.28906 - DOI - PubMed
    1. Qi X, Berzigotti A, Cardenas A, Sarin SK. Emerging non-invasive approaches for diagnosis and monitoring of portal hypertension. Lancet Gastroenterol Hepatol 2018; 3:708–719. doi: 10.1016/S2468-1253(18)30232-2 - DOI - PubMed
    1. Gunarathne LS, Rajapaksha H, Shackel N. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World J Gastroenterol 2020; 26:6111–6140. doi: 10.3748/wjg.v26.i40.6111 - DOI - PMC - PubMed
    1. Kerbert AJ, Chiang FW, van der Werf M, Stijnen T, Slingerland H, et al. Hemodynamic response to primary prophylactic therapy with nonselective beta-blockers is related to a reduction of first variceal bleeding risk in liver cirrhosis: a meta-analysis. Eur J Gastroenterol Hepatol 2017; 29:380–387. - PubMed

Substances