Role of probiotics in the treatment of minimal hepatic encephalopathy in patients with HBV-induced liver cirrhosis

Abstract

ObjectiveThis study was performed to investigate the role of probiotics (Clostridium butyricum combined with Bifidobacterium infantis) in the treatment of minimal hepatic encephalopathy (MHE) in patients with hepatitis B virus (HBV)-induced liver cirrhosis.MethodsSixty-seven consecutive patients with HBV-induced cirrhosis without overt hepatic encephalopathy were screened using the number connection test and digit symbol test. The patients were randomized to receive probiotics (n = 30) or no probiotics (n = 37) for 3 months. At the end of the trial, changes in cognition, intestinal microbiota, venous ammonia, and intestinal mucosal barriers were analyzed using recommended systems biology techniques.ResultsThe patients’ cognition was significantly improved after probiotic treatment. The predominant bacteria (Clostridium cluster I and Bifidobacterium) were significantly enriched in the probiotics-treated group, while Enterococcus and Enterobacteriaceae were significantly decreased. Probiotic treatment was also associated with an obvious reduction in venous ammonia. Additionally, the parameters of the intestinal mucosal barrier were obviously improved after probiotic treatment, which might have contributed to the improved cognition and the decreased ammonia levels.ConclusionTreatment with probiotics containing C. butyricum and B. infantis represents a new adjuvant therapy for the management of MHE in patients with HBV-induced cirrhosis.

Probiotics in Medicine: A Long Debate

“…Hepatic encephalopathy is closely related to the intestinal microbiota (162). The metabolic activity of the intestinal microbiota on amino-acids results in the production of toxic substances (NH3, phenols, amines, phenolic acids) that are inactivated in the liver.…”

Alterations of the Predominant Fecal Microbiota and Disruption of the Gut Mucosal Barrier in Patients with Early‐Stage Colorectal Cancer

“…Bacterial Genomic DNA Extraction. Fecal genomic DNA was extracted using a QIAamp® DNA Stool Mini Kit (QIAGEN, Hilden, Germany) according to our previous studies [4,19]. The amount of bacterial genomic DNA was analyzed using a NanoDrop ND-1000 spectrophotometer; the integrity and size of bacterial genomic DNA were checked by electrophoresis.…”

“…For fecal abundant bacteria analysis, real-time quantitative PCR (qPCR) was performed on ABI Prism 7900HT real-time PCR system (Applied Biosystems, Carlsbad, CA) with a Power SYBR Green PCR Master Mix (Takara, Dalian, China) according to the manufacturer's instructions. The bacterial primer sets and the reaction conditions are shown in Table 2 [19,20]. SDS 2.4 was used for the data analysis.…”

“…The plasma from each participants was collected for intestinal mucosal barrier function analysis. The parameters of gut mucosal barrier function such as endotoxin (LPS), D-lactate, and diamine oxidase (DAO) were detected by a dry chemical method using the Intestinal Mucosal Barrier Biochemical Index Analysis System (JY-DLT, Beijing Zhongsheng Jinyu Diagnostic Technology Co., Ltd., China) [19,21,22]. The experiments were undergone according to the protocols suggested by the manufacturer and conducted within 4 h after plasma extraction.…”

<p>Gut Microbiota, Peroxisome Proliferator-Activated Receptors, and Hepatocellular Carcinoma</p>

“…The intestinal barrier was improved after the probiotics treatment, resulting in a decreased level of venous ammonia and increased cognitive ability in patients with liver cirrhosis. 141 Accordingly, Dhiman et al 142 have found that the VSL#3 treatment in patients with liver cirrhosis reduces the risk of hospitalization for hepatic encephalopathy and decreases the severity of cirrhosis.…”