Hepatic Encephalopathy and Probiotic Treatment
Hepatic encephalopathy, observed in patients with cirrhosis, is a disorder of the brain function as
a result of liver failure and/or portosystemic shunt. Characteristic symptoms of hepatic
encephalopathy include confusion, drowsiness, coma, and sometimes death
1. According to the 2014 Practice Guidelines by AASLD and EASL, current treatment for hepatic
encephalopathy includes non-absorbable disaccharides, such as lactulose, and antibiotics such as
rifaximin. A recent, open-label study of lactulose, probiotics, or no therapy in patients with
cirrhosis who recovered from hepatic encephalopathy found fewer episodes of hepatic
encephalopathy in the lactulose or probiotic arms, compared to placebo
2. The concept of aproching hepatic encephalopathy with probiotics treatment has been suggested several
decades ago. Probiotic treatment aims at increasing the intestinal content of lactic acid-type
3. It is hypothesized that our intestinal flora may produce ammonia; therefore, treatment
for hepatic encephalopathy should be directed at lowering intestinal ammonia production. This
means that treatment must aim at the intestinal ammonia sources
4. In a study conducted by Lie Et Al, modulation of gut flora was associated with a significant
reduction in blood ammonia levels and a reversal of minimal hepatic encephalopathy in 50% of
patients; improved hepatic function and serum transaminase levels in patients with alcohol- and
hepatitis C-related cirrhosis have also been reported. Another group reported improvement in
biochemical and neuropsychological tests in cirrhotic patients receiving probiotics
3. Probiotics may be an effective treatment of hepatic encephalopathy, though rigorous evaluation
in standardized, randomized, clinical trial with clinically relevant outcomes is still needed.
1. McGee RG, Bakens A, Wiley K, Riordan SM, Webster AC. Probiotics for patients with
hepatic encephalopathy. Cochrane Database of Systematic Reviews 2011, Issue 11.
2. Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guidelines by AASLD
3. B´emeur C, Desjardins P, Butterworth RF. Role of Nutrition in theManagement of
Hepatic Encephalopathy in End-Stage Liver Failure. Journal of Nutrition and Metabolism
2010, Volume 2010, Article ID 489823.
4. Bongaerts G, Severjinen R, Timmerman H. Effect of antibiotics, prebiotics and probiotics
in treatment for hepatic encephalopathy Medical Hypotheses 2005: 64:64–68.