title: Probiotic yogurt for the treatment of minimal hepatic encephalopathy.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy (MHE), the preclinical stage of overt hepatic encephalopathy (OHE), is a significant condition affecting up to 60% of cirrhotics. All MHE therapies modify gut microflora, but consensus regarding MHE treatment and long-term adherence studies is lacking. The aim was to determine the effect of probiotic supplementation in the form of a food item, probiotic yogurt, on MHE reversal and adherence.
  
  
  METHODS
  Nonalcoholic MHE cirrhotics (defined by a standard psychometric battery) were randomized with unblinded allocation to receive probiotic yogurt (with proven culture stability) or no treatment (no Rx) for 60 days in a 2:1 ratio. Quality of life (short form [SF]-36), adherence, venous ammonia, model of end-stage liver disease (MELD) scores, and inflammatory markers (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6) were also measured. Outcomes were MHE reversal using blinded scoring, OHE development, and adherence.
  
  
  RESULTS
  Twenty-five patients (17 yogurt, 8 no Rx; 84% Child class A) were enrolled. A significantly higher percentage of yogurt patients reversed MHE compared to no Rx patients (71%vs 0%, P= 0.003, intention-to-treat). Yogurt patients demonstrated a significant improvement in number connection test-A (NCT-A), block design test (BDT), and digit symbol test (DST) compared to baseline/no Rx group. Twenty-five percent of no Rx versus 0% of yogurt patients developed OHE during the trial. Eighty-eight percent of yogurt patients were adherent. No adverse effects or change in covariates were observed. All patients who completed the yogurt arm were agreeable to continue yogurt for 6 months if needed.
  
  
  CONCLUSIONS
  This trial demonstrated a significant rate of MHE reversal and excellent adherence in cirrhotics after probiotic yogurt supplementation with potential for long-term adherence.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
authors.forename: Kia
authors.initials: K
authors.lastname: Saeian
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Christensen
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hafeezullah
authors.forename: Rajiv R
authors.initials: RR
authors.lastname: Varma
authors.forename: Jose
authors.initials: J
authors.lastname: Franco
authors.forename: Joan A
authors.initials: JA
authors.lastname: Pleuss
authors.forename: Glenn
authors.initials: G
authors.lastname: Krakower
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000641:Ammonia / Q000097:blood; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D010349:Patient Compliance; D019936:Probiotics / Q000627:therapeutic use*; D011788:Quality of Life; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014680:Veins; D015014:Yogurt
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D000641:Ammonia