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(searched for: Use of Probiotics as a Prophylaxis for Hepatic Encephalopathy: A Review Article)
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Farzan Salehi, Jennis Singla, Asma Nasir, Kefayatullah Nazary, Gurnoor Singh Bassi, Jennifer Alicea Maldonado, Apeksha Gupta, Maryam Zubair, Relfa Dellanira Proano, Simran Goraya, et al.
Archives of Internal Medicine Research, Volume 04, pp 77-83; doi:10.26502/aimr.0059

Abstract:
Hepatic Encephalopathy (HE) is a serious complication of liver cirrhosis and manifests as altered sensorium. It is precipitated by several factors but all these factors result in elevated ammonia levels. Minimal HE (MHE) is a mild form of HE and is not always easy to diagnose. It is mostly recognized by history, physical examination, and neurological tests that assess cognitive function. Altered microbiota in the gut is not uncommon in patients with cirrhosis and often leads to complications. Probiotics have been studied recently for possible use for primary and secondary prophylaxis of HE. Hence, in this review article, we aim to study the role of probiotics in HE prophylaxis. After applying the inclusion and exclusion criteria, we found 8 Randomized Controlled Trials (RCTs). Our results demonstrated that probiotics can be used for possible prophylaxis for MHE. They can be as good as rifaximin and lactulose, common agents occasionally used for prophylaxis. Furthermore, they can also be used for secondary prophylaxis of MHE. Having said that, the authors believe that there is a need to plan RCTs, aiming to use probiotics as a possible treatment for HE.
Tara Jawaro, Anna Yang, Deepali Dixit,
Published: 28 April 2016
Annals of Pharmacotherapy, Volume 50, pp 569-577; doi:10.1177/1060028016645826

Abstract:
Objective: To review the management of hepatic encephalopathy (HE), including lifestyle modifying strategies and pharmacological interventions. Data Sources: A literature search of PubMed through March 2016 was conducted utilizing the keywords hepatic encephalopathy, ammonia, and cirrhosis. All published articles evaluating treatments for HE were considered. Study Selection and Data Extraction: Available English-language data from reviews, abstracts, presentations, and clinical trials of the treatment of HE in humans were reviewed; relevant clinical data were selected and included. Data Synthesis: HE is a prevalent complication of portal hypertension and cirrhosis that results in altered mental status and neuropsychiatric impairment. Although the pathogenesis has not been elucidated, numerous treatment options exist. This review will explore the role of dietary interventions and supplements, including use of zinc, acetyl-l-carnitine, and probiotics, in the management of HE. Additionally, the use of various ammonia-lowering agents will be evaluated. The nonabsorbable disaccharides represent first-line therapies for the management and prophylaxis of HE; rifaximin use has been demonstrated to be effective for both treatment and prophylaxis of HE symptoms, with use relegated to those patients who fail to respond to or tolerate the nonabsorbable disaccharides. In light of toxicities associated with the use of neomycin and metronidazole, recent guidelines recommend both as alternatives for the treatment of HE, with the use of vancomycin discouraged. Conclusion: Although numerous treatment options are available, management of HE remains a clinical challenge. Additional research is needed to explore the pathogenesis and better understand the role of pharmacotherapy in managing this condition.
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