Effects of probiotic therapy on portal pressure in patients with cirrhosis: a pilot study.
BACKGROUND
Recent literature has supported the role of bacterial translocation as a mediator of splanchnic vasodilatation and portal hypertension. The objective of this study was to determine whether the probiotic VSL#3 would reduce portal pressure in patients with cirrhosis.


METHODS
Eight patients with compensated or very early decompensated cirrhosis and hepatic venous pressure gradient (HVPG) >10 mmHg, received 2 months of VSL#3 (3600 billion bacteria daily). The HVPG, intestinal permeability, endotoxin, tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, renin and aldosterone were measured at baseline and study end.


RESULTS
There was no change in the HVPG or intestinal permeability from baseline to study end but there was a trend to reduction in plasma endotoxin (P=0.09), a mild but significant increase in serum TNF-alpha (P=0.02) and a significant reduction in plasma aldosterone (P=0.03).


CONCLUSIONS
Within the limitations of small sample size, there does not appear to be a benefit of probiotic therapy for portal pressure reduction in patients with compensated or early decompensated cirrhosis. The reductions in endotoxin and aldosterone suggest possible beneficial effects of probiotics for this patient population. The clinical significance of the small but unexpected increase in TNF-alpha is unclear. Future studies are planned in patients with decompensated cirrhosis.
Tandon
Puneeta
P
Department of Medicine, University of Alberta, Edmonton, AB, Canada. ptandon@ualberta.ca
Moncrief
Karli
K
Madsen
Karen
K
Arrieta
Marie C
MC
Owen
Richard J
RJ
Bain
Vince G
VG
Wong
Winnie W
WW
Ma
Mang M
MM
D000450:Aldosterone / Q000097:blood; D018988:Bacterial Translocation; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000382:microbiology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010539:Permeability; D010865:Pilot Projects; D017082:Portal Pressure; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
C508606:CXCL8 protein, human; D004731:Endotoxins; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D000450:Aldosterone; D012083:Renin