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Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic

S Shukla1, A Shukla, S Mehboob

  • 1Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA.

Alimentary Pharmacology & Therapeutics
|January 22, 2011
PubMed
Abstract

Insights

Prebiotics, probiotics, and synbiotics significantly improve minimal hepatic encephalopathy (MHE). Lactulose showed the most benefit, followed by probiotics and synbiotics, with no major adverse events reported.

Area of Science:

  • Gastroenterology and Hepatology
  • Neuroscience
  • Microbiology

Background:

  • Minimal hepatic encephalopathy (MHE) presents with subtle neurocognitive deficits.
  • Current management strategies for MHE lack a definitive consensus.
  • Individual trials on prebiotics, probiotics, and synbiotics exist but require synthesis.

Purpose of the Study:

  • To systematically evaluate the efficacy of prebiotics, probiotics, and synbiotics in managing MHE.
  • To synthesize findings from randomized controlled trials (RCTs) on these interventions.
  • To establish a consensus on the management of MHE using gut microbiota-modulating agents.

Main Methods:

  • Comprehensive literature search across MEDLINE, EMBASE, CINAHL, and Cochrane Database.
  • Inclusion and exclusion criteria were predefined for study selection.
  • Pooled relative risk and heterogeneity were calculated to assess treatment effects.

Main Results:

  • Nine RCTs met the inclusion criteria.
  • Prebiotics, probiotics, and synbiotics significantly reduced the risk of MHE non-improvement (RR 0.40).
  • Lactulose demonstrated the strongest effect (RR 0.34), followed by probiotics (RR 0.41) and synbiotics (RR 0.51).

Conclusions:

  • Prebiotics, probiotics, and synbiotics are effective in improving MHE.
  • Lactulose, probiotics, and synbiotics offer significant benefits for MHE management.
  • These agents are well-tolerated, with probiotics and synbiotics showing better tolerance than lactulose.

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