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Bifidobacterium longum with fructo-oligosaccharide (FOS) treatment in minimal hepatic encephalopathy: a randomized,
Mariano Malaguarnera1, Filippo Greco, Gloria Barone
1Department of Senescence, Urological and Neurological Sciences, University of Catania, Viale Andrea Doria 69, 95126, Catania, Italy. malaguar@unict.it
Abstract:
Minimal hepatic encephalopathy (MHE) describes patients with chronic liver disease or cirrhosis who have no clinical symptoms of brain dysfunction but perform worse on psychometric tests compared with healthy subjects. The pathogenesis of hepatic encephalopathy is controversial although ammonia has been found to induce cerebral dysfunction. Increased intestinal ammonia production is due to bacterial urease activity and the production of other toxin methabolities, such as mercaptans, thioles. This study assesses the clinical efficacy of Bifidobacterium longum plus fructo-oligosaccharides (FOS) in the treatment of MHE. A total of 60 cirrhotic patients were randomly and equally divided into two groups receiving Bifidobacterium+FOS (17 males, 13 females; mean age, 46+/-11 years) or placebo (16 males, 14 females; mean age, 45+/-12 years), respectively. All patients underwent clinical and laboratory assessment psychometric tests and automated EEG analysis: neurophysiological assessment, liver function assessment, amd neuropsychological assessment. After 90 days of treatment, fasting NH(4) serum levels were significantly decreased (P=0.003), performance on Trail Making Test-A was significantly decreased (P=0.000), performance on Trail Making Test-B was significantly decreased (P=0.000), performance on the symbol digit modalities test was significantly improved (P<0.05), performance on block design was significantly improved (P=0.000), and performance on the MMSE test was significantly improved (P=0.000). We conclude that the improvement in biochemical and neuropsychological tests of the group treated with Bifidobacterium longum+FOS are interesting and merit further, close examination.
Insights
This study found that Bifidobacterium longum plus fructo-oligosaccharides (FOS) significantly improved cognitive function and reduced ammonia levels in patients with minimal hepatic encephalopathy (MHE). These findings suggest a potential therapeutic benefit for this probiotic and prebiotic combination in managing MHE.
Area of Science:
- Gastroenterology and Hepatology
- Neuroscience
- Microbiology
Background:
- Minimal hepatic encephalopathy (MHE) affects patients with chronic liver disease, characterized by cognitive deficits despite the absence of overt clinical symptoms.
- The exact pathogenesis of hepatic encephalopathy is unclear, but elevated ammonia levels and gut-derived toxins are implicated in cerebral dysfunction.
- Intestinal ammonia production is linked to bacterial urease activity and the generation of other metabolites like mercaptans.
Purpose of the Study:
- To evaluate the clinical efficacy of Bifidobacterium longum combined with fructo-oligosaccharides (FOS) in treating minimal hepatic encephalopathy (MHE).
Main Methods:
- A randomized controlled trial involving 60 cirrhotic patients diagnosed with MHE.
- Participants were equally divided into two groups: one receiving Bifidobacterium+FOS, the other receiving a placebo.
- Assessments included clinical evaluations, laboratory tests (serum ammonia), psychometric tests (Trail Making Test A & B, Symbol Digit Modalities Test, Block Design, MMSE), and automated EEG analysis.
Main Results:
- The Bifidobacterium+FOS group showed a significant reduction in fasting serum ammonia levels (P=0.003).
- Cognitive function significantly improved in the treatment group, with decreased scores on Trail Making Test A (P=0.000) and Trail Making Test B (P=0.000), indicating better executive function and processing speed.
- Significant improvements were also observed in the Symbol Digit Modalities Test (P<0.05), Block Design (P=0.000), and Mini-Mental State Examination (MMSE) (P=0.000).
Conclusions:
- Treatment with Bifidobacterium longum plus FOS led to significant improvements in both biochemical markers (serum ammonia) and neuropsychological test performance in MHE patients.
- The combination of Bifidobacterium longum and FOS demonstrates promising therapeutic potential for managing minimal hepatic encephalopathy.
- Further research is warranted to closely examine these beneficial effects and their long-term implications.
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