Probiotics for people with hepatic encephalopathy

Area of Science:

• Gastroenterology and Hepatology
• Microbiology and Immunology
• Neurology and Neuroscience

Background:

• Hepatic encephalopathy (HE) is a brain dysfunction resulting from liver failure or portosystemic shunts.
• Both overt and minimal HE significantly impair quality of life and increase healthcare burdens.
• Probiotics, live microorganisms conferring health benefits, are explored as a potential treatment for HE.

Purpose of the Study:

• To evaluate the beneficial and harmful effects of probiotics in patients with acute or chronic hepatic encephalopathy.
• To compare probiotics against placebo, no intervention, or other treatments for any grade of HE.
• This review excluded the primary prophylaxis of hepatic encephalopathy.

Main Methods:

• Systematic review and random-effects model meta-analysis of 21 randomized clinical trials (1420 participants).
• Searched multiple databases including Cochrane Hepato-Biliary Group Register, CENTRAL, MEDLINE, and Embase up to June 2016.
• Compared probiotics (various types, including VSL#3) against placebo/no treatment or lactulose, assessing outcomes like mortality, recovery, adverse events, and ammonia levels.

Main Results:

• Compared to placebo/no treatment, probiotics showed no effect on all-cause mortality but likely improved recovery rates (moderate-quality evidence).
• Probiotics may reduce overt hepatic encephalopathy development (low-quality evidence) and lower plasma ammonia concentrations (low-quality evidence).
• Effects on hospitalization, treatment withdrawal, and quality of life were uncertain or showed minimal improvement; no probiotic-related septicaemia was reported.

Conclusions:

• Probiotics likely improve recovery and may benefit overt HE, quality of life, and ammonia levels compared to placebo, but evidence quality is low.
• The efficacy of probiotics versus lactulose for hepatic encephalopathy is uncertain due to very low-quality evidence.
• High-quality randomized clinical trials with standardized data reporting are necessary to confirm the true efficacy of probiotics in HE management.