Probiotics could emerge as a reliable therapy in the near future to manage hepatic encephalopathy (HE), after a new study found that they significantly slowed the development of this very difficult-to-treat disease.

HE is caused by an accumulation of toxins in the blood that are normally removed by the liver. Typical symptoms include personality changes, intellectual impairment, confusion, altered consciousness and finally coma in the advanced stages as a result of liver failure that may even lead to death.

Diagnosis of HE requires confirmation of impaired liver function and excluding an alternative explanation for the symptoms. Blood tests for ammonia levels can help to confirm the diagnosis. Acute attacks are often precipitated by infections or constipation.

HE is reversible with treatment, which typically relies on suppressing production of toxic substances in the intestine. This is most commonly done with the laxative lactulose or with non-absorbable antibiotics. Additional treatment of any underlying conditions may also improve the symptoms. In clinical situations such as acute liver failure, HE may indicate the need for a liver transplant.

This study analyzed the efficacy of probiotics in preventing HE development in 160 patients with liver cirrhosis over a period of approximately nine months. It found significant reductions in ammonia levels in patients’ arteries after three months of probiotic treatment.

This is significant because ammonia produced by gut bacteria is believed to be one of the main reasons for brain dysfunction in HE. Probiotics work by enriching the gut flora with microorganisms which lower ammonia production. Probiotics are live microorganisms (mostly bacteria) that produce a health benefit on the host when administered in sufficient amounts.

In this study, twice as many patients taking a placebo developed HE when compared to patients taking probiotics in the form of a capsule.

These findings are likely to provide a boost to patients suffering from cirrhosis of the liver who are at risk of developing HE - and for whom the prognosis is typically very poor.

However, there is still a great deal of room for improvement and further studies are needed to determine if clinicians have in fact developed a successful treatment for HE.




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