Probiotics in hepatology: An update

Maslennikov, Roman; Ивашкин, В. Т.; Efremova, Irina; Poluektova, Elena; Широкова, Е. Н.

doi:10.4254/wjh.v13.i9.1154

Cited by 21 publications

(19 citation statements)

References 83 publications

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“…This is the first study to report these findings; further studies are warranted to investigate the mechanisms underlying these changes. We observed probiotic-induced reduction in the severity of hepatic encephalopathy, which is consistent with the results reported by previous research[ 28 ]. In our study, probiotic ingestion did not affect the degree of esophageal varices and prothrombin levels (indicated by the international normalized ratio); our results were consistent with those reported by a previous study[ 28 ].…”

Section: Discussionsupporting

confidence: 93%

“…Among these drugs, probiotics are live microorganisms, which when administered in adequate amounts confer several health benefits on the host[ 27 ]. Although evidence-based research supports the role of probiotics in cases of hepatic encephalopathy, their effects on other symptoms and manifestations of cirrhosis remain unclear[ 28 ]. A non-controlled study reported that a 6-wk course of probiotics reduced the cardiac output and heart rate and increased the SVR and serum sodium levels in the study population[ 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of probiotics on hemodynamic changes and complications associated with cirrhosis: A pilot randomized controlled trial

Maslennikov¹,

Efremova²,

Ивашкин³

et al. 2022

WJH

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BACKGROUND Bacterial translocation exacerbates the hyperdynamic circulation observed in cirrhosis and contributes to a more severe disease course. Probiotics may reduce bacterial translocation and may therefore be useful to redress the circulatory imbalance. AIM To investigate the effect of probiotics on hemodynamic parameters, systemic inflammation, and complications of cirrhosis in this randomized placebo-controlled trial. METHODS This single-blind randomized placebo-controlled study included 40 patients with Child-Pugh class B and C cirrhosis; 24 patients received probiotics ( Saccharomyces boulardii ) for 3 mo, and 16 patients received a placebo over the same period. Liver function and the systemic hemodynamic status were evaluated pre- and post-intervention. Echocardiography and simultaneous blood pressure and heart rate monitoring were performed to evaluate systemic hemodynamic indicators. Cardiac output and systemic vascular resistance were calculated. RESULTS Following a 3-mo course of probiotics in comparison to the control group, we observed amelioration of hyperdynamic circulation [a decrease in cardiac output ( P = 0.026) and an increase in systemic vascular resistance ( P = 0.026)] and systemic inflammation [a decrease in serum C-reactive protein levels ( P = 0.044)], with improved liver function [an increase in serum albumin ( P = 0.001) and a decrease in the value of Child-Pugh score ( P = 0.001)] as well as a reduction in the severity of ascites ( P = 0.022), hepatic encephalopathy ( P = 0.048), and cholestasis [a decrease in serum alkaline phosphatase ( P = 0.016) and serum gamma-glutamyl transpeptidase ( P = 0.039) activity] and an increase in platelet counts ( P < 0.001) and serum sodium level ( P = 0.048). CONCLUSION Probiotic administration was associated with amelioration of hyperdynamic circulation and the associated complications of cirrhosis.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Effect of probiotics on hemodynamic changes and complications associated with cirrhosis: A pilot randomized controlled trial

Maslennikov¹,

Efremova²,

Ивашкин³

et al. 2022

WJH

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“…The only study on the association of SIBO and hemodynamic disorders in cirrhosis was published[ 26 ]. An uncontrolled small study showed that probiotics can correct hemodynamic changes in cirrhosis[ 76 ]. Randomized controlled trials are required to confirm these findings.…”

Section: Connecting the Links Of The Gut–liver Axismentioning

confidence: 99%

Gut-liver axis in cirrhosis: Are hemodynamic changes a missing link?

Maslennikov¹,

Ивашкин²,

Efremova³

et al. 2021

WJCC

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Recent evidence suggests that the condition of the gut and its microbiota greatly influence the course of liver disease, especially cirrhosis. This introduces the concept of the gut–liver axis, which can be imagined as a chain connected by several links. Gut dysbiosis, small intestinal bacterial overgrowth, and intestinal barrier alteration lead to bacterial translocation, resulting in systemic inflammation. Systemic inflammation further causes vasodilation, arterial hypotension, and hyperdynamic circulation, leading to the aggravation of portal hypertension, which contributes to the development of complications of cirrhosis, resulting in a poorer prognosis. The majority of the data underlying this model were obtained initially from animal experiments, and most of these correlations were further reproduced in studies including patients with cirrhosis. However, despite the published data on the relationship of the disorders of the gut microbiota with the complications of cirrhosis and the proposed pathogenetic role of hemodynamic disorders in their development, the direct relations between gut dysbiosis and hemodynamic changes in this disease are poorly studied. They remain a missing link in the gut–liver axis and a challenge for future research.

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“…Probiotic is a general term for a group of active microorganisms that have beneficial roles by regulating intestinal flora growth and improving the host’s intestinal microecology. They regulate the intestinal microenvironment metabolism, increase SCFAs production, and reduce the permeability of the intestinal barrier[ 109 , 110 ]. Additionally, probiotics upregulate intestinal epithelial tight junction protein expression, improve intestinal motility[ 110 , 111 ], increase adhesion and colonization of intestinal flora, reduce TNF-α production, and maintain tissue homeostasis[ 112 ].…”

Section: Targeted Intestinal Flora Modulation For Psc Treatmentmentioning

confidence: 99%

Role of intestinal flora in primary sclerosing cholangitis and its potential therapeutic value

Li¹,

Gou²,

Zhang³

et al. 2022

World J Gastroenterol

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Primary sclerosing cholangitis (PSC) is an autoimmune disease characterized by chronic cholestasis, a persistent inflammation of the bile ducts that leads to sclerotic occlusion and cholestasis. Gut microbes, consisting of microorganisms colonized in the human gut, play an important role in nutrient intake, metabolic homeostasis, immune regulation, and immune regulation; however, their presence might aid PSC development. Studies have found that gut-liver axis interactions also play an important role in the pathogenesis of PSC. Patients with PSC have considerably reduced intestinal flora diversity and increased abundance of potentially pathogenic bacteria. Dysbiosis of the intestinal flora leads to increased intestinal permeability, homing of intestinal lymphocytes, entry of bacteria and their associated metabolites, such as bile acids, into the liver, stimulation of hepatic immune activation, and promotion of PSC. Currently, PSC effective treatment is lacking. However, a number of studies have recently investigated the targeted modulation of gut microbes for the treatment of various liver diseases (alcoholic liver disease, metabolic fatty liver, cirrhosis, and autoimmune liver disease). In addition, antibiotics, fecal microbiota transplantation, and probiotics have been reported as successful PSC therapies as well as for the treatment of gut dysbiosis, suggesting their effectiveness for PSC treatment. Therefore, this review briefly summarizes the role of intestinal flora in PSC with the aim of providing new insights into PSC treatment.

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Probiotics in hepatology: An update

Cited by 21 publications

References 83 publications

Effect of probiotics on hemodynamic changes and complications associated with cirrhosis: A pilot randomized controlled trial

Effect of probiotics on hemodynamic changes and complications associated with cirrhosis: A pilot randomized controlled trial

Gut-liver axis in cirrhosis: Are hemodynamic changes a missing link?

Role of intestinal flora in primary sclerosing cholangitis and its potential therapeutic value

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