Probiotic therapy: a promising addition to the therapeutic armamentarium of prophylactic therapies for patients with cirrhosis and previous hepatic encephalopathy

▸ Dhiman RK, Rana B, Agrawal S, et al. Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: a randomized, controlled trial. Gastroenterology 2014;147:1327–37.

This randomised controlled trial reports that daily VSL#3 monotherapy reduces hospitalisation rates for hepatic encephalopathy in patients, with established cirrhosis, who have recently been discharged following an episode hepatic encephalopathy.

Hepatic encephalopathy (HE) causes significant disability in patients with hepatic cirrhosis, occurring in up to 50% and being associated with a 1-year survival rate of <50%. The aetiology is incompletely understood, but is known to be related to portal hypertension, hyperammonaemia and an intestinal microbial dysbiosis. There is considerable interest in modulating the gut microbiota to correct the dysbiosis and reduce the volume of ammonia-producing organisms. Diet, antibiotics, correction of micronutrients and probiotics have all been studied. Randomised controlled trial (RCT) data and subsequent meta-analyses have shown the benefit of rifaximin in the secondary prevention of breakthrough HE, but …