Multistrain probiotics and lactulose in the treatment of minimal hepatic encephalopathy

Some evidence has shown benefits of probiotics in the management of minimal hepatic encephalopathy (MHE). We evaluated the efficacy of a multistrain probiotic compound, alone and in combination with lactulose, in the treatment of MHE. his study has two parts. First, consecutive adult patients with MHE were randomized to receive lactulose (30–60 mL/day) + probiotic (200 million colony forming units of seven bacteria species/day) (Gp-LPr) or lactulose + placebo (GpL). In second part, a non-randomized group of patients received probiotic alone (Gp-Pr). Medication duration was for 2 weeks and patients were followed-up for another 8 weeks. Improvement in MHE status was assessed by psychometric hepatic encephalopathy score (PHES). Development of overt encephalopathy, hospitalization, and death were considered as secondary outcomes. Sixty patients (80% male, mean age 38.4 ± 9.6 years) completed the intervention. PHES signi?cantly improved after medication in all the three groups (Gp-LPr:? 3.8 ± 3.9 to? 1.6 ± 3.0; Gp-L:? 4.8 ± 4.1 to? 1.6 ± 2.9; and Gp-Pr:? 4.9 ± 3.7 to? 2.1 ± 2.5, P < 0.001). After 8 weeks follow-up, improvement was maintained in Gp-LPr and Gp-Pr, but there was deterioration in those who did not receive probiotics (Gp-L: PHES score reversed to? 4.8 ± 4.2). Two patients (one each in Gp-L and Gp-Pr) experienced overt encephalopathy. One patient was hospitalized due to worsening of ascites (Gp-LPr) and one due to spontaneous bacterial peritonitis (Gp-L). Side effects were mild and not signi?cantly di?erent among the groups. Lactulose and probiotics are e?ective for the treatment of MHE; however, probiotics, but not lactulose, have long-term e?ects. More studies are required before suggesting probiotics for the standard treatment of MHE.