title: Synbiotic formulation of probiotic and lactulose combination for hepatic encephalopathy treatment: a realistic hope?
abstract: Gut-produced ammonia plays a vital role in the pathogenesis of hepatic encephalopathy because cirrhotic liver fails to clear toxic metabolites. Small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhosis add to the pathogenesis. Lactulose is a mainstay in the treatment of hepatic encephalopathy. Another benefit of lactulose is its prebiotic effect on probiotics that reduce the activity of bacterial urease, resulting in decreased hyperammoneamia and increased elimination of ammonia and other nitrogenous waste through enteric toxin reduction technology. Synbiotic formulation of probiotic and lactulose can synergistically/additively reduce ammonia production, increase utilization and excretion of ammonia and other nitrogenous wastes, thereby improving the well-being of patients with hepatic encephalopathy. We hypothesize that oral administration of a synbiotic formulation prepared from a combination of selected microbial strains of probiotics and lactulose will offer additional protection against hepatic encephalopathy via intra-intestinal extraction of toxic solutes in patients with cirrhosis.
authors.affiliation: Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal 576104, India. sonalsekhar@gmail.com
authors.forename: M Sonal
authors.initials: MS
authors.lastname: Sekhar
authors.forename: M K
authors.initials: MK
authors.lastname: Unnikrishnan
authors.forename: Gabriel Sunil
authors.initials: GS
authors.lastname: Rodrigues
authors.forename: Chiranjay
authors.initials: C
authors.lastname: Mukhopadhyay
mesh_terms: D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D007792:Lactulose / Q000008:administration & dosage*; D008962:Models, Theoretical; D019936:Probiotics
chemical_list: D007792:Lactulose