title: Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials.
abstract: Hepatic encephalopathy (HE) is a major complication of cirrhosis and is associated with decreased survival and increased health care utilization.
  
  
  
  The aim of this study was to evaluate the efficacy of probiotics in the management minimal hepatic encephalopathy HE (MHE) and overt HE (OHE) in comparison to no treatment/placebo and lactulose.
  
  
  
  The main outcomes measured were mortality, improvement in MHE, progression to OHE in patients with MHE and hospitalization. We calculated odds ratios (OR) with 95% confidence intervals (CI). Study heterogeneity was assessed using the I(2) statistic.
  
  
  
  Fourteen studies totalling 1152 patients were included in the analysis. The use of probiotics had no impact on the overall mortality when compared to either lactulose (OR: 1.07, 95% CI: 0.47-2.44, P = 0.88) or no treatment/placebo (OR: 0.69, 95% CI: 0.42-1.14, P = 0.15). When probiotics was compared to no treatment/placebo, it was associated with a significant improvement in MHE (OR: 3.91, 95% CI: 2.25-6.80, P < 0.00001), decreased hospitalization rates (OR: 0.53, 95% CI: 0.33-0.86, P = 0.01) and decreased progression to overt hepatic encephalopathy (OR: 0.40, 95% CI: 0.26-0.60, P < 0.0001). However when compared to lactulose, probiotics did not show a significant difference in improvement of MHE (OR: 0.81, 95% CI: 0.52-1.27, P = 0.35), hospitalization rates (OR: 1.02, 95% CI: 0.52-1.99, P = 0.96) or progression to overt hepatic encephalopathy (OR: 1.24, 95% CI 0.73-2.10, P = 0.42).
  
  
  
  Overall the use of probiotics was more effective in decreasing hospitalization rates, improving MHE and preventing progression to OHE in patients with underlying MHE than placebo, but similar to that seen with lactulose. The use of probiotics did not affect mortality rates.
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.|Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Department of Medicine, Olive View Medical Center, Sylmar, CA, USA.
authors.forename: Duminda
authors.initials: D
authors.lastname: Suraweera
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Au
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Elena G
authors.initials: EG
authors.lastname: Saab
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Tori S
authors.initials: TS
authors.lastname: Alper
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.|Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.|Liver Center, Huntington Medical Research Institutes, Pasadena, CA, USA.
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
mesh_terms: D018450:Disease Progression; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D007792:Lactulose / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications*; D019936:Probiotics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D007792:Lactulose
keywords: cirrhosis; hepatic encephalopathy; probiotics