| Popis: |
Background Hepatic encephalopathy (HE) involves a spectrum of potentally reversible neuropsychiatric abnormalities seen in patients with chonic liver disease or cirrhosis. However, clinicians frequently overlook its subclinical features, known as minimal hepatic encephalopathy (MHE). 80% of these cirrhotic patients are often not given preventive measures. By definition, MHE has no obvious clinical manifestations, often characterized by neurocognitive impairments in psychomotor speed, attention and visual perception. Ammonia is the key toxin in HE, where the highest levels are derived from both the urease- producing bacteria, leadsing to glutamine accumulation in the brain causing overt HE. Probiotics have multiple mechanisms that make them more superior than the conventional therapies, lactulose or poorly absorbed aantibiotics. Since probiotics are safe, natural and well-tolerated, probiotics for MHE may be ideal. They alter the gut mcirobiome which are crucial in the formation of ammonia, inducing an acidic colonic mileau which promotes acidifying bacteria, rather than the urease-producing bacteria. This mechanism prevents MHE from developing into an overt hepatic encephalopathy. This meta-analysis seeks to determine the efficacy of probiotics in improving MHE and help prevent these cirrhotic patients from developing overt hepatic encephalopathy. Methods Extensive literature search of 401 published articles from the year 2000–2017 was reviewed. After exclusion, four (4) randomized controlled studies were included in this meta-analysis, which involved 222 patients, 109 patients with MHE were given probiotics while 113 patients were placed in the placebo arm. The main outcome measures were an improvement in MHE and prevention of overt HE. Psychometric tests were used in the diagnosis and monitoring the progress of MHE. Odds ratio (OR) was calculated with 95% confidence interval (CI) while heterogeneity was assessed using the I2 statistics. Sensitivity testing was two-tailed and set at p-value of 0.05. The clinical efficacy was determined by the Mantel-Haenszel procedure for binary date. Results Improvement in MHE was improved significantly in the treatment group, compared to the placebo arm, was shown in this meta-analysis. (figure 1) Conclusions This meta-analysis shows that probiotics may be used to improve MHE and prevent overt HE. |
