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Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis
AIM OF THE STUDY: Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits have been shown to negatively affect their daily functioning and quality of life. Treatment with probiotics has...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10369659/ https://www.ncbi.nlm.nih.gov/pubmed/37502435 http://dx.doi.org/10.5114/ceh.2023.128768 |
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author | Wibawa, I Dewa Nyoman Mariadi, I Ketut Shalim, Christina Permata Sindhughosa, Dwijo Anargha |
author_facet | Wibawa, I Dewa Nyoman Mariadi, I Ketut Shalim, Christina Permata Sindhughosa, Dwijo Anargha |
author_sort | Wibawa, I Dewa Nyoman |
collection | PubMed |
description | AIM OF THE STUDY: Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits have been shown to negatively affect their daily functioning and quality of life. Treatment with probiotics has shown benefit in some clinical trials. This review aimed to systematically analyze the efficacy of probiotics in the treatment of MHE. MATERIAL AND METHODS: A systematic search of the electronic databases PubMed, Science Direct, and Cochrane Library was conducted for randomized controlled trials (RCTs) in adult patients with MHE who had been given probiotics intervention. The primary outcomes were reversal of MHE and improvement of neuropsychometric tests, while the secondary outcome was the reduction of serum ammonia. RESULTS: Nine RCTs involving 776 MHE patients were included, consisting of 311 patients receiving probiotics and 465 patients receiving comparator (placebo or no treatment, lactulose, L-ornithine L-aspartate [LOLA], or rifaximin). The meta-analysis showed that probiotics significantly reversed MHE (OR = 3.95, p < 0.0001, 95% CI: 2.05 to 7.60) compared with placebo or no treatment. Probiotics also significantly reduced serum ammonia compared with placebo (pooled mean difference –25.94, p = 0.04, 95% CI: –50.21 to –1.66). However when compared to lactulose and LOLA, probiotics did not show a significant difference in reversal of MHE or reduction of serum ammonia levels. CONCLUSIONS: Probiotics were more effective in reversal of MHE and reduced serum ammonia levels in patients with MHE compared to placebo or no treatment, but not more effective than lactulose or LOLA. |
format | Online Article Text |
id | pubmed-10369659 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-103696592023-07-27 Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis Wibawa, I Dewa Nyoman Mariadi, I Ketut Shalim, Christina Permata Sindhughosa, Dwijo Anargha Clin Exp Hepatol Original Paper AIM OF THE STUDY: Patients with minimal hepatic encephalopathy (MHE) have no recognizable clinical symptoms of hepatic encephalopathy (HE), but the mild cognitive and psychomotor deficits have been shown to negatively affect their daily functioning and quality of life. Treatment with probiotics has shown benefit in some clinical trials. This review aimed to systematically analyze the efficacy of probiotics in the treatment of MHE. MATERIAL AND METHODS: A systematic search of the electronic databases PubMed, Science Direct, and Cochrane Library was conducted for randomized controlled trials (RCTs) in adult patients with MHE who had been given probiotics intervention. The primary outcomes were reversal of MHE and improvement of neuropsychometric tests, while the secondary outcome was the reduction of serum ammonia. RESULTS: Nine RCTs involving 776 MHE patients were included, consisting of 311 patients receiving probiotics and 465 patients receiving comparator (placebo or no treatment, lactulose, L-ornithine L-aspartate [LOLA], or rifaximin). The meta-analysis showed that probiotics significantly reversed MHE (OR = 3.95, p < 0.0001, 95% CI: 2.05 to 7.60) compared with placebo or no treatment. Probiotics also significantly reduced serum ammonia compared with placebo (pooled mean difference –25.94, p = 0.04, 95% CI: –50.21 to –1.66). However when compared to lactulose and LOLA, probiotics did not show a significant difference in reversal of MHE or reduction of serum ammonia levels. CONCLUSIONS: Probiotics were more effective in reversal of MHE and reduced serum ammonia levels in patients with MHE compared to placebo or no treatment, but not more effective than lactulose or LOLA. Termedia Publishing House 2023-06-23 2023-06 /pmc/articles/PMC10369659/ /pubmed/37502435 http://dx.doi.org/10.5114/ceh.2023.128768 Text en Copyright © 2023 Clinical and Experimental Hepatology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/) ) |
spellingShingle | Original Paper Wibawa, I Dewa Nyoman Mariadi, I Ketut Shalim, Christina Permata Sindhughosa, Dwijo Anargha Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis |
title | Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis |
title_full | Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis |
title_fullStr | Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis |
title_full_unstemmed | Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis |
title_short | Efficacy of probiotics in the treatment of minimal hepatic encephalopathy: A systematic review and meta-analysis |
title_sort | efficacy of probiotics in the treatment of minimal hepatic encephalopathy: a systematic review and meta-analysis |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10369659/ https://www.ncbi.nlm.nih.gov/pubmed/37502435 http://dx.doi.org/10.5114/ceh.2023.128768 |
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