title: Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy (MHE) is diagnosed when hepatic patients perform worse on psychometric tests compared to healthy controls. This study aimed to evaluate probiotics as alternative therapy in MHE.
  
  
  METHODS
  This is an open-label randomised controlled trial, performed in the Department of Tropical Medicine and Infectious Diseases, Tanta University Hospitals, from March 2010 to January 2012. A total of 90 patients with MHE were allocated by simple randomisation to three parallel equal groups. Group A received lactulose, group B a probiotic (Lactobacillus acidophilus) and group C served as the control. After informed consent, patients were tested for gut micrecology, fasting blood ammonia, liver functions and magnetic resonance spectroscopy (MRS) examination to study brain metabolites, mainly choline (Cho), myo-inositol (mI), glutamine+glutamate (Glx) and creatinin (Cre). Patients who developed overt encephalopathy were excluded from analysis. The whole battery of investigations was repeated in the same order after 4weeks.
  
  
  RESULTS
  The probiotic was better tolerated than lactulose. The relative risk reduction (RRR) of developing overt encephalopathy was 60% in the case of lactulose and 80% in the case of probiotic, with a number needed to treat (NNT) of 2.4 and 2.3, respectively. The differential but not total microecology count was significantly shifted towards saccharolytic rather than proteolytic bacteria. The mI/Cre and (Cho+mI)/Glx ratios were significantly increased and the Glx/Cre ratio was significantly reduced after 1month-follow-up in the probiotic group compared to the lactulose group and in both treatment groups compared to the control group.
  
  
  CONCLUSIONS
  Both probiotic and lactulose therapy can improve blood ammonia and psychometric tests in MHE and reduce the risk of developing overt encephalopathy. MRS showed more improvement in the levels of brain neurometabolites in the probiotic group.
authors.affiliation: Tropical Medicine and Infectious Disease Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbia, Egypt. Electronic address: dhz646@hotmail.com.
authors.forename: Dina H
authors.initials: DH
authors.lastname: Ziada
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Soliman
authors.forename: Saher A
authors.initials: SA
authors.lastname: El Yamany
authors.forename: Manal F
authors.initials: MF
authors.lastname: Hamisa
authors.forename: Azza M
authors.initials: AM
authors.lastname: Hasan
mesh_terms: D000328:Adult; D000641:Ammonia / Q000097:blood; D001921:Brain / Q000378:metabolism*; D002794:Choline / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D041981:Gastrointestinal Tract / Q000382:microbiology*; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D007294:Inositol / Q000378:metabolism; D007779:Lactobacillus acidophilus; D007792:Lactulose / Q000627:therapeutic use; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005765:Gastrointestinal Agents; D005973:Glutamine; D018698:Glutamic Acid; D007792:Lactulose; D007294:Inositol; D000641:Ammonia; D003404:Creatinine; D002794:Choline
keywords: ANOVA; ARR; BDT; Cho; Cre; Creatinine; DST; Glx; HE; HRQOL; LTT; Lactobacillus acidophilus; MHE; MRS; Magnetic resonance spectroscopy (MRS); Minimal hepatic encephalopathy (MHE); NCT-A; NCT-B; NNT; RRR; SDT; absolute risk reduction; block design test; choline; digit symbol test; glutamine–glutamate; health-related quality of life; hepatic encephalopathy; line tracing test; mI; magnetic resonance spectroscopy; minimal hepatic encephalopathy; myo-inositol; number connection test-A; number connection test-B; number needed to treat; one-way analysis of variance; relative risk reduction; serial-dotting test