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Bifidobacterium combined with fructo-oligosaccharide versus lactulose in the treatment of patients with hepatic encephalopathy

Malaguarnera, Marianoa; Gargante, Maria Piaa; Malaguarnera, Giuliab; Salmeri, Mariob; Mastrojeni, Silvanab; Rampello, Liborioc; Pennisi, Giovannic; Volti, Giovanni Lid; Galvano, Fabiod

European Journal of Gastroenterology & Hepatology: February 2010 - Volume 22 - Issue 2 - p 199-206
doi: 10.1097/MEG.0b013e328330a8d3
Original Articles: Decompensated Liver Disease

Background Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome in patients with liver disease. It was suggested that Bifidobacterium+fructo-oligosaccharides (FOS) may decrease blood and brain ammonia levels.

Aim The study was conducted to compare the efficacy of Bifidobacterium+FOS and lactulose in patients with HE.

Methods One hundred and twenty-five patients (35 hepatitis B virus infected, 70 hepatitis C virus infected and 20 cryptogenetic cirrhosis) were enrolled in the study. Patients were randomized either to a treatment for 60 days with Bifidobacterium and FOS (group A) or into-group receiving lactulose (group B) in double-blind.

Results After 30 days of the study period, the Bifidobacterium+FOS-treated patients compared with lactulose-treated patients showed a significant decrease of Trail Making Test B (TMT B) (P<0.005), and a significant increase of Symbol Digit Modalities Test (P<0.001) and Block Design Test (P<0.001).

After 60 days of the study period, the Bifidobacterium+FOS-treated patients compared with lactulose-treated patients showed a significant decrease of NH4 fasting HE1 (P<0.001), TMT A (P<0.05), TMT B (P<0.001), and a significant increase of Symbol Digit Modalities Test (P<0.001) and Block Design Test (P<0.001).

Conclusion The treatment with Bifidobacterium+FOS is an alternative to the use of lactulose in patients with cirrhosis, for its usefulness in reducing blood ammonia levels and improvement of psychometric tests.

aDepartments of Senescence, Urological and Neurological Sciences

bMicrobiology

cNeurosciences

dBiochemistry, Medical Chemistry and Molecular Biology, University of Catania, Italy

Correspondence to Dr Mariano Malaguarnera, MD, PhD, Departments of Senescence, Urological and Neurological Sciences, Via Messina 829, Catania 95120, Italy

Tel: +39 95 7262008; fax: +39 95 7262011; e-mail: malaguar@unict.it

Received 17 April 2009 Accepted 9 July 2009

© 2010 Lippincott Williams & Wilkins, Inc.