Aa
Probiotics Cut Risk for Hepatic Encephalopathy in Half
Probiotics Cut Risk for Hepatic Encephalopathy in Half
Daniel M. Keller, PhD
May 01, 2013
AMSTERDAM, the Netherlands — Probiotics were effective in helping to prevent a first episode of overt hepatic encephalopathy in patients with cirrhosis, compared with patients not receiving probiotics, according to a new study.
"The patients in the control group had 2 times the chance of developing overt hepatic encephalopathy in the follow-up period," lead author Manish Lunia, MD, from the G.B. Pant Hospital in New Delhi, India, told delegates here at the International Liver Congress 2013.
It is estimated that hepatic encephalopathy occurs in 30% to 45% of patients with cirrhosis, and the mortality rate is 20% to 30%. Because bacterial overgrowth in the small intestine leads to endotoxemia, the researchers reasoned that probiotics could prevent the condition.
For their open-label, prospective, randomized trial, they enrolled patients 18 to 80 years of age with cirrhosis and no history of overt hepatic encephalopathy. A battery of psychometric tests, the critical flicker frequency test, and the psychometric hepatic encephalopathy score were used to diagnose encephalopathy. Glucose hydrogen breath tests were used to identify small intestinal bacterial overgrowth and lactulose hydrogen breath tests were used to identify orocecal transit time.
Study participants were randomly assigned to the probiotic group (n = 86) or the control group (n = 74). The researchers used the commercially available VSL#3, which is a mixture of nonurease-producing organisms: Streptococcus thermophilus and various species of Bifidobacterium and Lactobacillus (110 billion colony-forming units, 3 times daily).
There were no significant differences between the probiotic and control groups in terms of baseline age (about 44 to 47 years), sex, cause of cirrhosis, proportion of Child–Turcotte–Pugh classes, and model for end-stage liver disease (MELD) score. The groups also did not differ in various baseline laboratory parameters, such as small intestinal bacterial overgrowth (38.4% vs 35.1%) and the proportion of patients with minimal hepatic encephalopathy, defined as a psychometric hepatic encephalopathy score of 5 or lower (48.8% and 44.6%).
Patients were followed monthly for signs of overt hepatic encephalopathy or death (mean follow-up time, 38 to 40 weeks). Every 3 months, they underwent psychometric, arterial ammonia level, critical flicker frequency, glucose hydrogen, and lactulose hydrogen breath tests. Six probiotic patients and 5 control subjects were lost to follow-up.
More patients in the probiotic group than in the control group developed overt hepatic encephalopathy (8.8% vs 20.3%). Kaplan–Meier analysis revealed a hazard ratio for developing overt hepatic encephalopathy of 2.1 (95% confidence interval, 1.31 - 6.53; P < .05). There were fewer deaths in the probiotic group than in the control group (7.5% vs 11.5%).
A significantly greater proportion of patients with Child class B and C cirrhosis than with class A cirrhosis developed overt hepatic encephalopathy, but patients with Child class A and Child class B did not differ from each other (P = .36).
In the probiotic group, there were significant improvements from baseline to 3 months in arterial ammonia (P = .04), small intestinal bacterial overgrowth (P = .006), orocecal transit time (P = .05), psychometric hepatic encephalopathy score (P = .01), critical flicker frequency test (P = .02), and minimal hepatic encephalopathy (P = .001). In the control group, there were no significant differences from baseline in any of these parameters.
Factors significantly associated with the development of overt hepatic encephalopathy were minimal hepatic encephalopathy (adjust odds ratio [aOR], 3.1), Child–Turcotte–Pugh score (aOR, 1.6), small intestinal bacterial overgrowth (aOR, 2.1), and critical flicker frequency (aOR, 1.44).
Dr. Lunia reported that 5 patients with minimal hepatic encephalopathy or 31 patients without minimal hepatic encephalopathy would need to be treated to prevent 1 case of overt hepatic encephalopathy.
null
This study involved patients with a low level of hepatic encephalopathy at worst, and was therefore for prevention, not treatment, session moderator Isabelle Colle, MD, from Gent University in Belgium, who was not involved with the study, told Medscape Medical News. She explained that the use of probiotics is "certainly not" standard for such patients at this point.
She also questioned whether the use of probiotics in these patients is completely benign. "The gut permeability...is increased, so you can imagine that these bacteria can go through the intestine and cause bacterial translocation.... Do you see infections with this treatment?" she asked. It was a short study, and Dr. Lunia did not present any data on infections, Dr. Colle pointed out.
Dr. Lunia and Dr. Colle have disclosed no relevant financial relationships.
International Liver Congress 2013: 48th Annual Meeting of the European Association for the Study of the Liver (EASL). Abstract 78. Presented April 26, 2013.
http://www.medscape.com/viewarticle/803453
Daniel M. Keller, PhD
May 01, 2013
AMSTERDAM, the Netherlands — Probiotics were effective in helping to prevent a first episode of overt hepatic encephalopathy in patients with cirrhosis, compared with patients not receiving probiotics, according to a new study.
"The patients in the control group had 2 times the chance of developing overt hepatic encephalopathy in the follow-up period," lead author Manish Lunia, MD, from the G.B. Pant Hospital in New Delhi, India, told delegates here at the International Liver Congress 2013.
It is estimated that hepatic encephalopathy occurs in 30% to 45% of patients with cirrhosis, and the mortality rate is 20% to 30%. Because bacterial overgrowth in the small intestine leads to endotoxemia, the researchers reasoned that probiotics could prevent the condition.
For their open-label, prospective, randomized trial, they enrolled patients 18 to 80 years of age with cirrhosis and no history of overt hepatic encephalopathy. A battery of psychometric tests, the critical flicker frequency test, and the psychometric hepatic encephalopathy score were used to diagnose encephalopathy. Glucose hydrogen breath tests were used to identify small intestinal bacterial overgrowth and lactulose hydrogen breath tests were used to identify orocecal transit time.
Study participants were randomly assigned to the probiotic group (n = 86) or the control group (n = 74). The researchers used the commercially available VSL#3, which is a mixture of nonurease-producing organisms: Streptococcus thermophilus and various species of Bifidobacterium and Lactobacillus (110 billion colony-forming units, 3 times daily).
There were no significant differences between the probiotic and control groups in terms of baseline age (about 44 to 47 years), sex, cause of cirrhosis, proportion of Child–Turcotte–Pugh classes, and model for end-stage liver disease (MELD) score. The groups also did not differ in various baseline laboratory parameters, such as small intestinal bacterial overgrowth (38.4% vs 35.1%) and the proportion of patients with minimal hepatic encephalopathy, defined as a psychometric hepatic encephalopathy score of 5 or lower (48.8% and 44.6%).
Patients were followed monthly for signs of overt hepatic encephalopathy or death (mean follow-up time, 38 to 40 weeks). Every 3 months, they underwent psychometric, arterial ammonia level, critical flicker frequency, glucose hydrogen, and lactulose hydrogen breath tests. Six probiotic patients and 5 control subjects were lost to follow-up.
More patients in the probiotic group than in the control group developed overt hepatic encephalopathy (8.8% vs 20.3%). Kaplan–Meier analysis revealed a hazard ratio for developing overt hepatic encephalopathy of 2.1 (95% confidence interval, 1.31 - 6.53; P < .05). There were fewer deaths in the probiotic group than in the control group (7.5% vs 11.5%).
A significantly greater proportion of patients with Child class B and C cirrhosis than with class A cirrhosis developed overt hepatic encephalopathy, but patients with Child class A and Child class B did not differ from each other (P = .36).
In the probiotic group, there were significant improvements from baseline to 3 months in arterial ammonia (P = .04), small intestinal bacterial overgrowth (P = .006), orocecal transit time (P = .05), psychometric hepatic encephalopathy score (P = .01), critical flicker frequency test (P = .02), and minimal hepatic encephalopathy (P = .001). In the control group, there were no significant differences from baseline in any of these parameters.
Factors significantly associated with the development of overt hepatic encephalopathy were minimal hepatic encephalopathy (adjust odds ratio [aOR], 3.1), Child–Turcotte–Pugh score (aOR, 1.6), small intestinal bacterial overgrowth (aOR, 2.1), and critical flicker frequency (aOR, 1.44).
Dr. Lunia reported that 5 patients with minimal hepatic encephalopathy or 31 patients without minimal hepatic encephalopathy would need to be treated to prevent 1 case of overt hepatic encephalopathy.
null
This study involved patients with a low level of hepatic encephalopathy at worst, and was therefore for prevention, not treatment, session moderator Isabelle Colle, MD, from Gent University in Belgium, who was not involved with the study, told Medscape Medical News. She explained that the use of probiotics is "certainly not" standard for such patients at this point.
She also questioned whether the use of probiotics in these patients is completely benign. "The gut permeability...is increased, so you can imagine that these bacteria can go through the intestine and cause bacterial translocation.... Do you see infections with this treatment?" she asked. It was a short study, and Dr. Lunia did not present any data on infections, Dr. Colle pointed out.
Dr. Lunia and Dr. Colle have disclosed no relevant financial relationships.
International Liver Congress 2013: 48th Annual Meeting of the European Association for the Study of the Liver (EASL). Abstract 78. Presented April 26, 2013.
http://www.medscape.com/viewarticle/803453
Thank you so much for your recommendation. I see it on Amazon and will get it next month
Dee
Dee
Quality of Probiotic Supplements Questioned
People who take supplements that are supposed to contain beneficial bacteria (probiotics) may not be getting their money’s worth, according to a study presented by researchers from Bastyr University (Kenmore, WA) at an American Public Health Association meeting. The finding that some of these products do not contain viable bacteria or are contaminated with other potentially harmful bacteria raises concerns about the safety and efficacy of these products.
The intestinal tract contains billions of beneficial bacteria that perform various necessary functions, such as aiding in the digestion and absorption of food and protecting the body against microorganisms that can cause infection. While there are dozens of different types of friendly bacteria, Lactobacillus acidophilus, L. bulgaricus, L. thermophilus, L. reuteri, and Bifidobacterium bifidum are some of the more common strains found in the gut. Studies suggest that taking supplements containing these bacteria can help boost immune function and prevent or relieve certain health conditions including irritable bowel syndrome, vaginal yeast infections, and traveler’s diarrhea. However, commercially available probiotic products that do not contain what they are purported to contain will not deliver these benefits.
According to this new report, laboratory testing of 12 refrigerated and 8 non-refrigerated, randomly selected probiotic supplements obtained from different health food stores revealed that only one product contained the same bacteria as those listed on the label. Many of the refrigerated products had some beneficial bacteria, but contained fewer species of organisms than the label claimed. More than 30% of all supplements were contaminated with other microorganisms and 50% of the non-refrigerated products were completely dead. Dead probiotics have no impact on improving intestinal function or restoring the balance of normal intestinal flora.
The deficiencies found in these probiotic supplements may be due to poor manufacturing processes, poor quality control, or other environmental factors that cause the bacteria to deteriorate. While some probiotics are stable at room temperature, most require refrigeration to maintain live cultures. The findings in the new study suggest that many probiotic supplements will provide no benefit due to lack of viable organisms and may cause infection if contaminated with organisms that cause disease. However, no reports have been published linking a probiotic supplement to an intestinal infection. It is unclear at this point whether there are any adverse effects from the bacterial contaminants found in probiotic supplements.
Despite the quality-control concerns with probiotic supplements, many of the available products appear to be safe and effective in clinical practice. The one product that contained exactly what was listed on the label was Lactobacillus GG, a specific strain of beneficial bacteria. Studies have shown that Lactobacillus GG is useful in treating acute and chronic intestinal infections, preventing eczema in children, and stimulating the immune system.
Choosing a probiotic supplement can be difficult since it is not possible to know whether the product contains live cultures at the time of purchase. Selecting a refrigerated product may be more beneficial, since they were found to be more likely to contain live bacteria. If taking a particular product does not appear to be effective, some physicians recommend trying another product before discontinuing the treatment altogether. Probiotics may also be found in some cultured dairy products, such as some yogurt products and some types of milk. However, people with a dairy allergy or lactose intolerance may prefer taking a supplement. Some physicians recommend taking a supplement that contains 3 to 5 billion live organisms per day in between meals.
Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.
Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.
People who take supplements that are supposed to contain beneficial bacteria (probiotics) may not be getting their money’s worth, according to a study presented by researchers from Bastyr University (Kenmore, WA) at an American Public Health Association meeting. The finding that some of these products do not contain viable bacteria or are contaminated with other potentially harmful bacteria raises concerns about the safety and efficacy of these products.
The intestinal tract contains billions of beneficial bacteria that perform various necessary functions, such as aiding in the digestion and absorption of food and protecting the body against microorganisms that can cause infection. While there are dozens of different types of friendly bacteria, Lactobacillus acidophilus, L. bulgaricus, L. thermophilus, L. reuteri, and Bifidobacterium bifidum are some of the more common strains found in the gut. Studies suggest that taking supplements containing these bacteria can help boost immune function and prevent or relieve certain health conditions including irritable bowel syndrome, vaginal yeast infections, and traveler’s diarrhea. However, commercially available probiotic products that do not contain what they are purported to contain will not deliver these benefits.
According to this new report, laboratory testing of 12 refrigerated and 8 non-refrigerated, randomly selected probiotic supplements obtained from different health food stores revealed that only one product contained the same bacteria as those listed on the label. Many of the refrigerated products had some beneficial bacteria, but contained fewer species of organisms than the label claimed. More than 30% of all supplements were contaminated with other microorganisms and 50% of the non-refrigerated products were completely dead. Dead probiotics have no impact on improving intestinal function or restoring the balance of normal intestinal flora.
The deficiencies found in these probiotic supplements may be due to poor manufacturing processes, poor quality control, or other environmental factors that cause the bacteria to deteriorate. While some probiotics are stable at room temperature, most require refrigeration to maintain live cultures. The findings in the new study suggest that many probiotic supplements will provide no benefit due to lack of viable organisms and may cause infection if contaminated with organisms that cause disease. However, no reports have been published linking a probiotic supplement to an intestinal infection. It is unclear at this point whether there are any adverse effects from the bacterial contaminants found in probiotic supplements.
Despite the quality-control concerns with probiotic supplements, many of the available products appear to be safe and effective in clinical practice. The one product that contained exactly what was listed on the label was Lactobacillus GG, a specific strain of beneficial bacteria. Studies have shown that Lactobacillus GG is useful in treating acute and chronic intestinal infections, preventing eczema in children, and stimulating the immune system.
Choosing a probiotic supplement can be difficult since it is not possible to know whether the product contains live cultures at the time of purchase. Selecting a refrigerated product may be more beneficial, since they were found to be more likely to contain live bacteria. If taking a particular product does not appear to be effective, some physicians recommend trying another product before discontinuing the treatment altogether. Probiotics may also be found in some cultured dairy products, such as some yogurt products and some types of milk. However, people with a dairy allergy or lactose intolerance may prefer taking a supplement. Some physicians recommend taking a supplement that contains 3 to 5 billion live organisms per day in between meals.
Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.
Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.
I just remember that HepatitisResearcher once said that lactulose could be used as a preventative...probiotic
I just started using Ultimate Flora which starts out with 15 billion strains. The difference between this and what I was taking is amazing.
I am going to try the one referenced in the article when I have the $. It is shipped cold
McKansas, thank you for the article, very helpul
I just started using Ultimate Flora which starts out with 15 billion strains. The difference between this and what I was taking is amazing.
I am going to try the one referenced in the article when I have the $. It is shipped cold
McKansas, thank you for the article, very helpul
I just started using Ultimate Flora which starts out with 15 billion strains. The difference between this and what I was taking is amazing.
--------------------------------------------------------------------------------------------
I have noticed a big difference too. Thanks Dee.
--------------------------------------------------------------------------------------------
I have noticed a big difference too. Thanks Dee.
COMMUNITY LEADER
Are you both experiencing a reduction in the symptoms of a hepatic encephalopathy? Or what specific benefits are you both experiencing?
Randy
P.s. sorry I haven't been in the group much lately we just had a new house built and it's going to be a while before they can get cable ran back to us here for Internet. So its just me and my smartphone and it's not very smart lol
Randy
P.s. sorry I haven't been in the group much lately we just had a new house built and it's going to be a while before they can get cable ran back to us here for Internet. So its just me and my smartphone and it's not very smart lol
Have an Answer?
You are reading content posted in the Cirrhosis of the Liver Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
