Benefit of probiotics in preventing hepatic encephalopathy among patients with liver cirrhosis: an evidence-based case report

Authors

  • Anak Agung Yunda Prabundari Internist, H. Marsidi Judono Marsidi Judono Regional General Hospital, Belitung, Indonesia

DOI:

https://doi.org/10.36216/jpd.v6i1.178

Keywords:

Hepatic encephalopaty, cirrhosis, probiotics, prevention

Abstract

Background: Hepatic encephalopathy (HE) is a serious complication in patients with liver cirrhosis. Its pathogenesis involved the mechanism of HE including endotoxins, ammonia production and other neurotoxins by gut microflora. Probiotic exert potential benefit for gastrointestinal microflora. The use of probiotics may provide substantial benefit for the treatment of HE.

Objective: This report aimed to evaluate the benefit of probiotics in preventing HE among liver cirrhosis patients.

Methods: Literature searching with keywords of ‘liver cirrhosis’, ‘probiotics’, ‘hepatic encephalopathy’ along with its synonyms and related terms was implemented in Pubmed. Additional hand-search was implemented to obtain the relevant articles

Result: Three meta-analyses showed that probiotics are effective to prevent HE development. All meta-analyses obtained similar results, in which the odds ratio (OR) obtained was ranging from 0.22 to 0.42. One randomized controlled trial (RCT) by Dhiman et al showed that probiotics treatment reduces the relative risk of overt HE by 33% compared to placebo.

Conclusion: Probiotics administration exert potential to prevent the development of HE in the liver cirrhotic patients. The patient may benefit with the given of probiotics.

Downloads

Download data is not yet available.

Author Biography

  • Anak Agung Yunda Prabundari, Internist, H. Marsidi Judono Marsidi Judono Regional General Hospital, Belitung, Indonesia

    Internist, H. Marsidi Judono Marsidi Judono Regional General Hospital, Belitung, Indonesia

References

Salehi F, Singla J, Nasir A, et al. Use of probiotics as a prophylaxis for hepatic encephalopathy: a review article. Archives of Internal Medicine Research. 2021;4:077- 083.

Lunia KM, Sharma BC, Harma P, et al. Probiotics prevent hepatic encephalopathy in patients with cirrhosis: a randomized controlled trial. Clinical Gastroenterology and Hepatology. 2014;12:1003–1008.

Bustamante J, Rimola A, Ventura PJ, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 1999;30:890–895.

Rahimi RS, Rockey DC. Complications of cirrhosis. Curr Opin Gastroenterol. 2012;28:223–229.

Liu J, Xu Y, Jiang B. Novel insights into pathogenesis and therapeutic strategies of hepatic encephalopathy, from the gut microbiota perspective. Front Cell Infect Microbiol. 2021;11:586427.

Chen Y, Yang F, Lu H, et al. Characterization of fecal microbial communities in patients with liver cirrhosis. Hepatology. 2011;54:562–572.

Liu Q, Duan ZP, Ha DK, et al. Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology. 2004;39:1441–1449.

Gupta A, Dhiman RK, Kumari S, et al. Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. J Hepatol. 2010;53:849–855.

Mouli VP, Benjamin J, Singh MB, et al. Effects of probiotic VSL#3 in the treatment of minimal hepatic encephalopathy: A non-inferiority randomized controlled trial. Hepatol Res. 2015;45(8):880-889.

Xu J, Ma R, Chen L, et al. Effects of probiotic therapy on hepatic encephalopathy in patients with liver cirrhosis: an updated meta-analysis of six randomized controlled trials. Hepatobiliary & Pancreatic Diseases International. 2014;13(4):354-360.

Cao Q, Yu C, Yang S, et al. Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy: A meta-analysis. Hepatobiliary & Pancreatic Diseases International. 2018;17(1):9-16.

Dhiman R, Thumburu K, Verma N, et al. Comparative efficacy of treatment options for minimal hepatic encephalopathy: a systematic review and network meta-analysis. Clinical Gastroenterology And Hepatology. 2020;18(4):800-812.e25.

Dhiman RK, Rana B, Agrawal S, et al. Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: a randomized, controlled trial. Gastroenterology. 2014;147:1327-1337.e3.

Solga SF. Probiotics can treat hepatic encephalopathy. Med Hypotheses. 2003;61:307–313.

Dhiman RK. Gut microbiota and hepatic encephalopathy. Metab Brain Dis. 2013;28:321–326.

Sharma BC, Singh J. Probiotics in management of hepatic encephalopathy. Metab Brain Dis. 2016;31(6):1295-1301.

Cordoba J. Hepatic encephalopathy: from the pathogenesis to the new treatments. ISRN Hepatol. 2014;2014:236268.

Downloads

Published

2022-07-13

How to Cite

1.
Benefit of probiotics in preventing hepatic encephalopathy among patients with liver cirrhosis: an evidence-based case report. Udayana In. Med. [Internet]. 2022 Jul. 13 [cited 2025 Mar. 23];6(1):6-9. Available from: https://jpdunud.org/index.php/JPD/article/view/178