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

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.

Perceived Stress and Self-Prescribing Behavior: A Preliminary Cross-Sectional Study among Specialized Residency Training in Indonesia

“…Lack of knowledge about the dangers and risks of antibiotic misuse can encourage inappropriate use of these drugs. [8][9][10][11] The behavior of self-prescribing medication can indicate that stress is an important factor that can encourage self-prescribing behavior. [12][13][14][15][16] Although this study did not find a clear association between total PSS scores and self-prescribing behavior, it is important to note that these findings do not exclude the possibility of stress as a contributing factor.…”

Antibiotics in Chronic Liver Disease and Their Effects on Gut Microbiota

“…Additionally, targeting gut microbial metabolites and their receptors may offer novel therapeutic options for the management of portal hypertension [40,43]. In fact, bacterial-derived products may increase hyperdynamic circulation and intrahepatic vascular resistance, promoting a further increase in portal pressure and the risk of bleeding [44][45][46].…”