Aim:Despite extensive ongoing research, there is scarcity of widely accepted therapeutic options for the treatment of nonalcoholic fatty liver disease (NAFLD). Probiotics are a promising treatment option for treating NAFLD; however, their effectiveness needs to be established. Since any single randomized controlled trial (RCT) cannot establish the role of probiotics in the treatment of NAFLD, this study aims at meta-analysis of different RCTs.Materials and methods:Extensive search was done by two independent observers for RCTs studying the role of probiotics in the treatment of NAFLD. The parameters under consideration were body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), homeostatic model assessment of insulin resistance (HOMA-IR), serum triglycerides (TGs), and ultrasonographic grades of fatty liver. Jadad scale was used to select the articles for meta-analysis. Heterogeneity in the results was evaluated using chi-square test and I2. Significant heterogeneity in the results was decided based on p-value < 0.05 and the corresponding I2 close to 0%.Results:Seven studies qualified for meta-analysis. Use of probiotics significantly caused reduction in BMI (p < 0.0001), ALT (p < 0.0001), AST (< 0.0001), HOMA-IR (p = 0.006), and ultrasonographic grade of fatty liver (p = 0.0051). Heterogeneity in other parameters was contributed mainly by couple of previous studies.Conclusion:Meta-analysis shows that variety of parameters has significant improvement after probiotic treatment in different RCTs. However, the magnitude of improvement is not uniform across studies due to varying strains, dose patterns, and treatment duration. In future, probiotics remain a promising option for treating NAFLD.How to cite this article: Lavekar AS, Raje DV, Manohar T, Lavekar AA. Role of Probiotics in the Treatment of Nonalcoholic Fatty Liver Disease: A Meta-analysis. Euroasian J Hepato-Gastroenterol 2017;7(2):130-137.

Prevalence of NAFLD was found be 28.1%. Study confirms that the increased BMI, metabolic syndrome, increased fasting blood glucose and serum triglycerides are potentially strong indicators of NAFLD.

Background: Progressive Coronary Artery Disease (CAD) remains asymptomatic in many cases of type 2 diabetes mellitus (DM) and this makes diagnosis difficult. Routine screening of type 2 DM for silent ischemia with electrocardiography (ECG) remains controversial as majority of patients present with normal ECG. This study aims at using Treadmill Test (TMT) to determine the percentage of ischemic heart disease (IHD) in diabetic patients, having normal resting ECG and 2D Echo, in a rural set up of Central India. Moreover, the interest is to determine the risk factors for IHD in patients who underwent TMT. Materials and methods:One hundred sixty one type 2 DM patients in the age range 30-60 years with normal baseline ECG and resting Echo were screened by TMT. The data on demographics, biochemical tests and micro vascular complications was obtained for each patient to determine the possible risk factors of IHD in this study population.Results: Thirty four out of 161 patients (21.1%) were found positive for exercise induced ischemia. Of these, 27 underwent exercise stress echo immediately after TMT and the presence of RWMA was confirmed in 20 patients. Age, duration of DM and family history of IHD were identified as major covariates in the study. The parameters like HbA 1 C (glycosylated hemoglobin), total cholesterol (TC), triglycerides (TG) and low density lipoprotein (LDL) showed marginal increase of odds in favor of TMT positive result after adjusting for covariates. Nephropathy and retinopathy were associated with silent ischemia in the study population exposed to TMT. Discussion:The study group belonged to lower socioeconomic group with mostly moderate to heavy working life style. Patients had normal resting echo, but when subjected to TMT, a significant proportion of cases were positive for silent ischemia, which otherwise would have been unnoticed. We believe that TMT remains the cornerstone for screening the population at risk in the rural sector where angiography is not readily available.

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Radio frequency ablation (RFA) involves use of thermal energy to perform ablation of tissues. It has a wide range of application in gastrointestinal tract. Over the last few years, several studies have reported successful and safe application in the biliary and pancreatic tissues. It is particularly beneficial in patients with biliary malignancies in whom it has shown to improve survival. Additionally, it can be applied in occluded metal stents secondary to tumor ingrowth to prolong the patency of stents. In pancreas, RFA can successfully ablate cystic lesions and neuroendocrine tumors. It has also been applied in unresectable pancreatic cancers. This review discusses the application of endobiliary and pancreatic RFAs.