Probiotic Therapy in Patients with Nonalcoholic Steatohepatitis in Zagazig University Hospitals

Abstract

Aim:Nonalcoholic fatty liver disease (NAFLD) is probably the most common liver disorder in the world. A subgroup of NAFLD patients is characterized by injury to the hepatocytes and inflammation in addition to excessive fat (steatohepatitis), the latter condition is nominated nonalcoholic steatohepatitis (NASH). This work aimed to evaluate the role of probiotics on the outcome of NASH in patients admitted to the Tropical Medicine Department, Faculty of Medicine, Zagazig University (inpatients and outpatients).Materials and methods:This study was performed on 30 patients (17 males and 13 females), with body mass index from 30 to 35 and average age of 44 years with bright fatty liver in ultrasonography and raised alanine transaminase (ALT) and aspartate transaminase (AST) and positive liver biopsy findings. The patients were divided into group I (case group) that included 15 patients who received probiotics and group II of 15 patients as control group who did not receive probiotics; the study was conducted between November 2014 and April 2016. Clinical assessment, laboratory evaluation, pelvic-abdominal ultrasound, and liver biopsy of all cases were carried out.Results:In this study, there was significant decrease in liver enzymes (ALT and AST) and no statistically significant other laboratory findings. Also there was relief for dyspepsia in some patients.Conclusion:Probiotics treatment is effective, safe, well-tolerated, inexpensive, appropriate for long-term use, and optimally, works at multiple levels to downregulate inflammatory mediators, and therefore, probiotics could be an option in the treatment of NASH.How to cite this article: Monem SMA. Probiotic Therapy in Patients with Nonalcoholic Steatohepatitis in Zagazig University Hospitals. Euroasian J Hepato-Gastroenterol 2017;7(1):101-106.

The Therapeutic Implications of the Gut Microbiome and Probiotics in Patients with NAFLD

“…International studies have also observed similar results [56]. An Egyptian study by Abdel Monem with Zigazag University randomized NASH patients to probiotic Acidophilus capsule (2 billion Lactobacillus acidophilus ) or placebo for 17 months and measured improved AST and ALT in treated patients [56]. Wang et al compared the effectiveness of various probiotics with a control in 200 NAFLD patients and measured significantly improved liver function tests in all probiotics groups versus the control, but no significance between them [57].…”

“…A 72-NAFLD-patient double-blind study by Nabavi et al compared treatment with 300g/d of probiotic yogurt with Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 versus conventional yogurt and noted improved hepatic enzymes, total cholesterol, and LDL cholesterol [55]. International studies have also observed similar results [56]. An Egyptian study by Abdel Monem with Zigazag University randomized NASH patients to probiotic Acidophilus capsule (2 billion Lactobacillus acidophilus ) or placebo for 17 months and measured improved AST and ALT in treated patients [56].…”

“…At least six clinical studies that assessed serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) to evaluate liver function demonstrated significant improvement with probiotic and symbiotic treatment [52,53,54,55,56,57]. An early study by Aller et al shed light on the usage of a 500-million Lactobacillus bulgaricus and Streptococcus thermophilus tablet in NAFLD patients per day versus a placebo tablet daily, and noted significant improvement in both liver function enzymes in the probiotics group and no change in the control [52].…”

“…All studies reviewed reported no adverse effects or issues of safety with the clinical use of probiotics in patients with NAFLD [52,53,54,55,56,57,60,61,62,63,64,65,66,67]. In the evaluation of these studies, a potential fallback noted was the lack of proper time duration of the study to observe any long-term effects of probiotic use and whether the termination of probiotics reverted the gut microbiome to its previous state before treatment was initiated.…”

Microbiota-Associated Therapy for Non-Alcoholic Steatohepatitis-Induced Liver Cancer: A Review

“…have been reported to reduce gut inflammation and improve gut barrier function by remodeling the gut microbiota [ 119 ]. In humans, administration of Lactobacillus acidophilus reduced AST and ALT levels in NASH patients [ 120 ] and several clinical trials of probiotics were reported in other reviews [ 121 ]. However, most of the molecular mechanisms by which probiotics exert their functions remain unclear.…”