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Meta-Analysis
. 2024 Dec;44(12):3164-3173.
doi: 10.1111/liv.16081. Epub 2024 Sep 12.

Meta-analysis of probiotics efficacy in the treatment of minimum hepatic encephalopathy

Yu-Lian Zhou  1 , Shu-Tao Pu  1 , Jian-Bo Xiao  1 , Jun Luo  1 , Li Xue  1
Affiliations
Meta-Analysis

Meta-analysis of probiotics efficacy in the treatment of minimum hepatic encephalopathy

Yu-Lian Zhou et al. Liver Int. 2024 Dec.

Abstract

Objective: This study aims to systematically evaluate the efficacy of probiotics in treating minimum hepatic encephalopathy (MHE).

Methods: A systematic search was conducted across three major databases: PubMed, China National Knowledge Infrastructure and Wanfang. The search period spanned from the inception of each database to 9 March 2023. The objective was to identify all randomised controlled trials (RCTs) examining the efficacy of probiotic preparations in treating MHE. The search terms included 'probiotics' along with other clinically relevant terms to comprehensively capture all pertinent studies.

Results: A total of 18 RCTs were included. The meta-analysis showed that probiotic treatment outperformed control groups in reducing blood ammonia levels (standard mean difference [MD] = -2.68, 95% confidence interval [CI]: -3.90 to -1.46, p < .0001), improving the remission rate of MHE (risk ratio [RR] = 2.79, 95% CI: 1.23-6.35, p = .01) and lowering alanine aminotransferase levels (MD = -11.10, 95% CI: -16.17 to -6.03, p < .0001). It also significantly reduced the Model for End-Stage Liver Disease scores (MD = -2.55, 95% CI: -3.56 to -1.54, p < .00001) and the incidence of MHE (RR = .18, 95% CI: .09-.34, p < .00001).

Conclusion: Our study demonstrates that probiotics effectively improve blood ammonia levels, liver function and cognitive function in patients with MHE. They significantly enhance the remission rate of MHE and effectively reduce its incidence, providing solid new evidence for treating MHE with probiotics.

Keywords: meta‐analysis; minimum hepatic encephalopathy; probiotics; randomised controlled trial.

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Conflict of interest statement

All of the authors had no any personal, financial, commercial or academic conflicts of interest separately.

Figures

FIGURE 1
FIGURE 1
Literature screening process and results.
FIGURE 2
FIGURE 2
Risk of bias assessment of included studies (Cochrane bias risk assessment tool).
FIGURE 3
FIGURE 3
Meta‐analysis of the effect of probiotics on blood ammonia level in patients with MHE.
FIGURE 4
FIGURE 4
Meta‐analysis of the effect of probiotics on ALT levels in MHE patients.
FIGURE 5
FIGURE 5
Meta‐analysis of the effect of probiotics on NCT reaction time in MHE patients.
FIGURE 6
FIGURE 6
Meta‐analysis of the effect of probiotics on DST score in MHE patients.
FIGURE 7
FIGURE 7
Meta‐analysis of the effect of probiotics on MELD score in MHE patients.
FIGURE 8
FIGURE 8
Meta‐analysis of the effect of probiotics on MHE remission rate in MHE patients.
FIGURE 9
FIGURE 9
Meta‐analysis of the effect of probiotics on the incidence of OHE in MHE patients.
See this image and copyright information in PMC

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