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


OBJECTIVE
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).


CONCLUSIONS
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.
Malaguarnera
Mariano
M
Department of Senescence, Urological and Neurological Sciences, University of Catania, Catania 95120, Italy. malaguar@unict.it
Gargante
Maria Pia
MP
Malaguarnera
Giulia
G
Salmeri
Mario
M
Mastrojeni
Silvana
S
Rampello
Liborio
L
Pennisi
Giovanni
G
Li Volti
Giovanni
G
Galvano
Fabio
F
D000328:Adult; D000641:Ammonia / Q000097:blood; D001644:Bifidobacterium / Q000254:growth & development*; D003071:Cognition; D004311:Double-Blind Method; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000382:microbiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007792:Lactulose / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009844:Oligosaccharides / Q000009:adverse effects / Q000627:therapeutic use*; D056692:Prebiotics / Q000009:adverse effects; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D011594:Psychometrics; D013997:Time Factors; D016896:Treatment Outcome
D009844:Oligosaccharides; D056692:Prebiotics; C116580:fructooligosaccharide; D007792:Lactulose; D000641:Ammonia