title: Use of Lactobacillus casei rhamnosus to Prevent Cholangitis in Biliary Atresia After Kasai Operation.
abstract: OBJECTIVE
  Recurrent cholangitis may aggravate cholestatic liver cirrhosis in biliary atresia (BA) after the Kasai operation. This pilot study aimed to investigate whether Lactobacillus casei rhamnosus has the prophylactic efficacy for recurrent cholangitis in comparison with the conventional neomycin prophylaxis.
  
  
  METHODS
  Twenty jaundice-free patients with BA ages 0 to 3 years who underwent a Kasai operation were enrolled and randomized into 2 groups with 10 patients each: neomycin (25 mg · kg · day for 4 days/wk) and L casei rhamnosus (8 × 10 colony-forming unit per day) groups. The treatment duration was 6 months. Bacterial stool cultures were performed before treatment and 1, 3, and 6 months after starting treatment. In addition, 10 patients with BA with similar status but without prophylaxis served as the historical control group.
  
  
  RESULTS
  In the Lactobacillus group, 2 patients (20%, mean 0.03 ± 0.07 episodes per month) developed cholangitis during the study period, with the same frequency as in the neomycin group and significantly lower than that in the control group (80%, P = 0.005, mean 0.22 ± 0.16 episodes per month). The mean change in body weight z score during the 6 months in the Lactobacillus group was 0.97 ± 0.59, which was significantly better than that in the control group (-0.01 ± 0.79, P = 0.006). In bacterial stool cultures, the Lactobacillus and Escherichia coli populations significantly increased and decreased, respectively, in the Lactobacillus group.
  
  
  CONCLUSIONS
  The use of L casei rhamnosus was as effective as neomycin in preventing cholangitis in patients with BA who underwent Kasai operation, and therefore could be considered as a potential alternative prophylactic regimen.
authors.affiliation: *Department of Pediatrics, National Taiwan University Hospital, Taipei †Department of Pediatrics, Keelung Hospital, Department of Health, Executive Yuan, Keelung ‡Department of Pediatrics, China Medical University Hospital, School of Medicine, China Medical University, Taichung §Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan ||Department of Pediatrics, Kaohsiung Medical University Hospital, School of Medicine, Kaohsiung Medical University, Kaohsiung ¶Department of Pediatrics, Chi-Mei Hospital, Tainan, Taiwan.
authors.forename: Tien-Hau
authors.initials: TH
authors.lastname: Lien
authors.forename: Ling-Nan
authors.initials: LN
authors.lastname: Bu
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Wu
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: An-Chyi
authors.initials: AC
authors.lastname: Chen
authors.forename: Ming-Wei
authors.initials: MW
authors.lastname: Lai
authors.forename: Hsiang-Hung
authors.initials: HH
authors.lastname: Shih
authors.forename: I-Hsien
authors.initials: IH
authors.lastname: Lee
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Hsu
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001656:Biliary Atresia / Q000601:surgery*; D001835:Body Weight; D002761:Cholangitis / Q000209:etiology / Q000517:prevention & control*; D018572:Disease-Free Survival; D004926:Escherichia coli / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007778:Lactobacillus / Q000302:isolation & purification; D007780:Lacticaseibacillus casei; D052201:Lacticaseibacillus rhamnosus; D008297:Male; D009355:Neomycin / Q000627:therapeutic use; D010865:Pilot Projects; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects; D019936:Probiotics / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents; D009355:Neomycin