Use of Probiotics as a Prophylaxis for Hepatic Encephalopathy: A Review Article

Author(s): Farzan Salehi, Jennis Singla, Asma Nasir, Kefayatullah Nazary, Gurnoor Singh Bassi, Jennifer Alicea Maldonado, Apeksha Gupta, Maryam Zubair, Relfa Dellanira Proano, Simran Goraya, Edith Bermudez-Wa

Hepatic Encephalopathy (HE) is a serious complication of liver cirrhosis and manifests as altered sensorium. It is precipitated by several factors but all these factors result in elevated ammonia levels. Minimal HE (MHE) is a mild form of HE and is not always easy to diagnose. It is mostly recognized by history, physical examination, and neurological tests that assess cognitive function. Altered microbiota in the gut is not uncommon in patients with cirrhosis and often leads to complications. Probiotics have been studied recently for possible use for primary and secondary prophylaxis of HE. Hence, in this review article, we aim to study the role of probiotics in HE prophylaxis. After applying the inclusion and exclusion criteria, we found 8 Randomized Controlled Trials (RCTs). Our results demonstrated that probiotics can be used for possible prophylaxis for MHE. They can be as good as rifaximin and lactulose, common agents occasionally used for prophylaxis. Furthermore, they can also be used for secondary prophylaxis of MHE. Having said that, the authors believe that there is a need to plan RCTs, aiming to use probiotics as a possible treatment for HE.

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