Intestinal flora, probiotics, and cirrhosis

Hernández, Ignacio Guerrero; Delgadillo, Aldo Torre; Vorácková, Florencia Vargas; Uribe, Misael

doi:10.1016/s1665-2681(19)31866-6

Cited by 19 publications

(7 citation statements)

References 35 publications

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“…Cirrhotic patients suffer from a high risk of bacterial infection (4–54%) including spontaneous bacterial peritonitis, pneumonia, urinary tract infections and bacteraemia . Probiotics were shown to decrease infection rates in liver transplant recipients in a placebo‐controlled, double blind study .…”

Section: Discussionmentioning

confidence: 52%

Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis

Horvath

Leber

Schmerboeck

et al. 2016

Aliment Pharmacol Ther

105

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SummaryBackgroundProbiotics may correct intestinal dysbiosis and proinflammatory conditions in patients with liver cirrhosis.AimTo test the effects of a multispecies probiotic on innate immune function, bacterial translocation and gut permeability.MethodsIn a randomised, double blind, placebo‐controlled study, stable cirrhotic out‐patients either received a daily dose of a probiotic powder containing eight different bacterial strains (Ecologic Barrier, Winclove, Amsterdam, The Netherlands) (n = 44) or a placebo (n = 36) for 6 months and were followed up for another 6 months.ResultsWe found a significant but subclinical increase in neutrophil resting burst (2.6–3.2%, P = 0.0134) and neopterin levels (7.7–8.4 nmol/L, P = 0.001) with probiotics but not with placebo. Probiotic supplementation did not have a significant influence on neutrophil phagocytosis, endotoxin load, gut permeability or inflammatory markers. Ten severe infections occurred in total; one during intervention in the placebo group, and five and four after the intervention has ended in the probiotic and placebo group, respectively. Liver function showed some improvement with probiotics but not with placebo.ConclusionsProbiotic supplementation significantly increased serum neopterin levels and the production of reactive oxygen species by neutrophils. These findings might explain the beneficial effects of probiotics on immune function. Furthermore, probiotic supplementation may be a well‐tolerated method to maintain or even improve liver function in stable cirrhosis. However, its influence on gut barrier function and bacterial translocation in cirrhotic patients is minimal.

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Section: Discussionmentioning

confidence: 52%

Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis

Horvath

Leber

Schmerboeck

et al. 2016

Aliment Pharmacol Ther

105

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“…These may lead to changes in the anatomical or functional aspects of the tight junctions (leaky gut), resulting in bacterial translocation and increased intestinal permeability. In these conditions, fragments of bacteria or their metabolites reach the liver directly through the portal system and/or also the general circulation and may start or worsen liver damage . Lactobacillus and Bifidobacteria species are the most common strains present in commercial probiotic/prebiotic preparations, and they are used to treat liver damage caused by alcohol, metabolic syndrome and hepatitis viruses both in animals and in humans .…”

mentioning

confidence: 99%

Symbiotic formulation in experimentally induced liver fibrosis in rats: intestinal microbiota as a key point to treat liver damage?

D’Argenio

Cariello

Tuccillo

et al. 2013

Liver International

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“…The reason is that Patients with cirrhosis often need a lot of antibiotics during the treatment, which will lead to the imbalance of intestinal flora and the increase of pathogenic flora, and then produce a large number of enterotoxins and metabolic waste. When the intestinal mucosal barrier function is damaged, these enterotoxins and metabolic waste will easily penetrate the intestinal wall and invade the lymphatic system, causing body infection, especially lung infection [23–25] . Probiotics can improve the intestinal micro ecological environment, enhance the intestinal barrier function, prevent the invasion of foreign bacteria, stimulate the immune response of the body, inhibit the production of endotoxin, repair the intestinal mucosal barrier, reduce inflammatory factors and promote the absorption of enteral nutrition [26] .…”

Section: Discussionmentioning

confidence: 99%

The efficacy of parenteral nutrition (PN) and enteral nutrition (EN) supports in cirrhosis

Wang

2022

Medicine

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Importance: Multiple nutritional therapies are currently available for patients with liver cirrhosis, yet many interventions have not been compared head-to-head within randomized clinical trials. Objective: To evaluate the improvement of nutritional indicators and liver function indexes of liver cirrhosis treated with different nutrition intervention. Data source: We searched PubMed, Embase. com and Cochrane Library database from construction to April 3, 2020. After eliminating the duplicated or overlapping reports, 6 studies were included. We performed a Bayesian network meta-analysis by Stata 12.0 and GeMTC 0.14.3 in order to compare different nutritional interventions with consistency model. Study selection: Randomized clinical trials comparing 2 or more therapies in patients with cirrhosis were evaluated. Six randomized clinical trials met the selection criteria. Data extraction and synthesis: Two investigators independently reviewed the full manuscripts of eligible studies and extracted information into an electronic database: patients’ characteristics study design, interventions, the number of events of interest in each group. Main outcomes and measures: Body mass index, Child-Pugh score, model for end-stage liver disease score, total bilirubin, alanine transaminase, aspartate transaminase, total protein, Triceps skinfold, Midarm Muscle Circumference, Fischer ratio, overall survival. Results: There are 6 studies enrolling a total of 1148 patients who received different nutrition supports including parenteral nutrition (PN), enteral nutrition (EN), EN (without branched-chain amino acids), EN + intestinal probiotics, PN + EN, late evening snacks (LES), EN + LES, noLES. The direct comparisons showed that the effect of EN was better than EN (without branched-chain amino acids); EN + intestinal probiotics was better than EN and PN; PN + EN was better than them alone; EN + LES was better than LES and EN; LES was better than noLES. Although the difference of indirect comparisons between the included regimens was not statistically significant, the results showed that EN + intestinal probiotics appeared to be superior to PN + EN. While LES and EN + LES seemed to rank behind them and the difference between them was extremely small. Conclusion and relevance: Available evidence suggests that EN + intestinal probiotics appear to be the most effective strategy for patients with cirrhosis compared with other interventions.

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Intestinal flora, probiotics, and cirrhosis

Cited by 19 publications

References 35 publications

Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis

Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis

Symbiotic formulation in experimentally induced liver fibrosis in rats: intestinal microbiota as a key point to treat liver damage?

The efficacy of parenteral nutrition (PN) and enteral nutrition (EN) supports in cirrhosis

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