1Departments of Surgery, University of California at Los Angeles, Los Angeles, California.
2Medicine, University of California at Los Angeles, Los Angeles, California.
3Department of Medicine, Olive View Medical Center, Sylmar, California.
4Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
5The Liver Center, Huntington Medical Research Institutes, Pasadena, California.
To evaluate the efficacy of probiotics in the management minimal hepatic encephalopathy HE (MHE) and overt HE (OHE) in comparison to no treatment/placebo and lactulose METHODS: The main outcomes measured were mortality, improvement in MHE, progression to OHE in patients with MHE, and hospitalization. We calculated odds ratios (OR) with 95% confidence intervals (CI). Study heterogeneity was assessed using the I2 statistic.
Fourteen studies totaling 1152 patients were included in the analysis. The use of probiotics had no impact on the overall mortality when compared to either lactulose (OR 1.07, CI 0.47 to 2.44, p value = 0.88) or no treatment/placebo (OR 0.69, CI 0.42 to 1.14, p=0.15). When probiotics was compared to no treatment/placebo it was associated with a significant improvement in MHE (OR 3.91, CI 2.25 to 6.80, p < 0.00001), decreased hospitalization rates (OR 0.53, CI 0.33 to 0.86, p=0.01) and decreased progression to overt hepatic encephalopathy (OR 0.40, CI 0.26 to 0.60, p <0.0001). However when compared to lactulose, probiotics did not show a significant difference in improvement of MHE (OR 0.81, CI 0.52 to 1.27, p= 0.35), hospitalization rates (OR 1.02, CI 0.52 to 1.99, p=0.96) or progression to overt hepatic encephalopathy (OR 1.24, CI 0.73 to 2.10, p= 0.42).
Overall the use of probiotics was more effective in decreasing hospitalization rates, improving MHE, and preventing progression to OHE in patients with underlying MHE than placebo, but similar to that seen with lactulose. The use of probiotics did not affect mortality rates.