Synbiotic modulation of gut flora improves minimal hepatic encephalopathy in cirrhotic patients

Some cirrhotic patients develop brain dysfunction, called hepatic encephalopathy, which causes deficits in behavior, intelligence, consciousness and neuromuscular function. When the dysfunction is minor, it is called minimal hepatic encephalopathy (MHE). Since ammonia has been shown to play a key role in overt hepatic encephalopathy, treatment options for MHE have also focused on reducing ammonia levels in the body.

A new study published in the May 2004 issue of Hepatology has shown that treating cirrhotic patients with synbiotics or fermentable fiber can alter the flora in the gut, lowering its pH levels as well as the ammonia levels in the blood. Both treatments improved clinical signs of brain and liver dysfunction. They may be useful alternatives to lactulose for the management of MHE.

Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc., is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

To consider the effect of synbiotics and fermentable fiber on gut flora and MHE, a collaborative research team from Beijing Youan Hospital and Capital University of Medical Sciences, China, University College London, England and the Prince of Wales Hospital, Sydney, Australia conducted a pilot, placebo-controlled study of 55 individuals with MHE. Twenty of the patients were treated for 30 days with a daily symbiotic preparation. Twenty took fermentable fibers for 30 days, and fifteen received a placebo treatment for 30 days. At 30 days, all patients were re-screened for MHE. The researchers also assessed gut flora in fecal samples at day 1, day 30, and day 44. They compared their findings with the gut flora of 20 normal healthy volunteers.

After 30 days of treatment, 50 percent of patients treated with either the synbiotic preparation or ferment

Contact: David Greenberg
John Wiley & Sons, Inc.

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