Probiotics for people with hepatic encephalopathy

摘要: Background Hepatic encephalopathy is a disorder of brain function as result liver failure or portosystemic shunt both. Both hepatic (clinically overt) and minimal (not clinically significantly impair patient’s quality life daily functioning, represent significant burden on healthcare resources. Probiotics are live micro-organisms, which when administered in adequate amounts, may confer health benefit the host. Objectives To determine beneficial harmful effects probiotics any dosage, compared with placebo no intervention, other treatment for people grade acute chronic encephalopathy. This review did not consider primary prophylaxis encephalopathy. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, conference proceedings, reference lists included trials, World Health Organization International Clinical Registry Platform until June 2016. Selection criteria We randomised clinical trials that dosage encephalopathy. Data collection analysis We used standard methodological procedures expected by Collaboration. We conducted random-effects model meta-analysis due to obvious heterogeneity participants interventions. defined P value 0.05 less significant. expressed dichotomous outcomes risk ratio (RR) continuous mean difference (MD) 95% confidence intervals (CI). Main results We 21 1420 participants, these, 14 were new trials. Fourteen probiotic treatment, seven lactulose. variety probiotics; most commonly group was VSL#3, proprietary name eight probiotics. Duration administration ranged from 10 days 180 days. Eight declared their funding source, six independently funded two industry funded. remaining 13 disclose source. classified 19 at high bias. We found effect all-cause mortality (7 trials; 404 participants; RR 0.58, CI 0.23 1.44; low-quality evidence). No-recovery (as measured incomplete resolution symptoms) lower treated (10 574 0.67, 0.56 0.79; moderate-quality Adverse events than intervention considering development overt 585 0.29, 0.16 0.51; evidence), but hospitalisation change of/or withdrawal uncertain (hospitalisation: 3 163 0.11 4.00; very evidence; treatment: 9 551 0.70, 0.46 1.07; slightly improve (3 115 results meta-analysed; Plasma ammonia concentration 705 MD -8.29 μmol/L, -13.17 -3.41; There reports septicaemia attributable trial. When lactulose, (2 200 5.00, 0.25 102.00; evidence); lack recovery 430 1.01, 0.85 1.21; adverse (6 420 1.17, 0.63 2.17; (1 trial; 80 0.33, 0.04 3.07; intolerance leading discontinuation 220 0.35, 0.08 1.43; 490 1.27, 0.88 1.82; (results 1 69 participants); plasma overall 325 -2.93 -9.36 3.50; trial. Authors' conclusions The majority suffered systematic error (‘bias’) random (‘play chance’). Accordingly, we evidence be low quality. Compared probably lead improvements encephalopathy, life, concentrations, little mortality. Whether better lactulose because available low. High-quality standardised outcome data reporting needed further clarify true efficacy