title: Effects of probiotics (cultured Lactobacillus subtilis/Streptococcus faecium) in the treatment of alcoholic hepatitis: randomized-controlled multicenter study.
abstract: BACKGROUND
  Probiotics might reduce gut-derived microbial lipopolysaccharide (LPS) by restoring bowel flora in patients with alcoholic hepatitis (AH). We evaluated the therapeutic effects of probiotics in patients with AH.
  
  
  METHODS
  Between September 2010 and April 2012, 117 patients (probiotics 60 and placebo 57) were prospectively randomized to receive the 7 days of cultured Lactobacillus subtilis/Streptococcus faecium (1500 mg/day) or placebo. All patients were hospitalized and were not permitted to consume alcohol for the 7 days of the study. Liver function test, proinflammatory cytokines, LPS, and colony-forming units by stool culture were examined and compared after therapy.
  
  
  RESULTS
  In both groups, the mean levels of aspartate aminotransferase/alanine aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, bilirubin, and prothrombin time were significantly improved after 7 days of abstinence. In the probiotics group (baseline and after), albumin (3.5 ± 0.7 and 3.7 ± 0.6 g/dl, P=0.038) and tumor necrosis factor-α (121 ± 244 and 71 ± 123 pg/ml, P=0.047) showed differences. In addition, the number of colony-forming units of Escherichia coli was significantly reduced (435 ± 287 and 168 ± 210, P=0.002). In the placebo group, the level of LPS (1.7 ± 2.8 and 2.0 ± 2.7 EU/ml) was significantly increased. In the intergroup comparison, significant differences in the levels of tumor necrosis factor-α (P=0.042) and LPS (P=0.028) were observed between the groups.
  
  
  CONCLUSIONS
  Immediate abstinence is the most important treatment for patients with AH. In addition, 7 days of oral supplementation with cultured L. subtilis/S. faecium was associated with restoration of bowel flora and improvement of LPS in patients with AH.
authors: aDepartment of Pathology bDepartment of Internal Medicine cDepartment of Laboratory Medicine, Hallym University College of Medicine dCenter for Efficacy Assessment and Development of Functional Foods and Drugs, Hallym University eDepartment of Internal Medicine, Kangwon University College of Medicine, Chuncheon fDepartment of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju gDepartment of Internal Medicine, Ulsan University College of Medicine, Gangneung hDepartment of Emergency Medical Technology, Daewon University College, Jecheon, South Korea.
authors: Sang Hak
authors: SH
authors: Han
authors: Ki Tae
authors: KT
authors: Suk
authors: Dong Joon
authors: DJ
authors: Kim
authors: Moon Young
authors: MY
authors: Kim
authors: Soon Koo
authors: SK
authors: Baik
authors: Young Don
authors: YD
authors: Kim
authors: Gab Jin
authors: GJ
authors: Cheon
authors: Dae Hee
authors: DH
authors: Choi
authors: Young Lim
authors: YL
authors: Ham
authors: Dong Hoon
authors: DH
authors: Shin
authors: Eun Ji
authors: EJ
authors: Kim
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015169:Colony Count, Microbial; D016984:Enterococcus faecium; D004926:Escherichia coli / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007778:Lactobacillus; D008070:Lipopolysaccharides / Q000032:analysis; D008297:Male; D008875:Middle Aged; D019936:Probiotics / Q000627:therapeutic use*; D011517:Prothrombin Time; D012709:Serum Albumin / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D008070:Lipopolysaccharides; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin