Abstract

ROLE OF PROBIOTICS IN DECREASING AMMONIA LEVELS. CAN THEY BE USED AS A TREATMENT OF HEPATIC ENCEPHALOPATHY?

Sajjad Hussain Chandio, Tehreem Fatima, Binish Hassan, Saliha Jabeen, Hassan Mumtaz, Muhammad Owais, Ayesha Fatima, Fatima Meer

Abstract

Introduction: Hepatic encephalopathy (HE) is associated with poor prognosis in patients with advanced liver disease. The major pathophysiological mechanism involved in development of HE is raised ammonia levels. Several medications can decrease ammonia levels. Recently, role of probiotics in lowering ammonia levels has been a hot topic of interest. It has already been studies for primary and secondary prophylaxis but use of probiotics for HE treatment has not been studied. Objective of our study was to compare mean change in serum ammonia level with probiotics in the management of hepatic encephalopathy. Subjects & Methods: A total of 60 patients fulfilling selection criteria were enrolled in the study. In group-A (study group), patients were given probiotics along with standard treatment. In group-B (reference group), patients were given standard treatment plus placebo. Probiotics were lactobacillus reuteri 100 million cfu OD daily for two weeks. Standard treatment for acute hepatic encephalopathy as per AASLD guidelines was given. Patients were followed up in OPD after 2 weeks. The reduction in serum ammonia level was calculated (as per operational definition). Data were entered and analyzed by using SPSS v25.0. Data were stratified for age, gender, and grade of hepatic encephalopathy. Post-stratification, an independent sample t-test was applied. A p-value ≤0.05 was taken as significant for all statistical tests in the study. Results: A total of 60 patients presenting with hepatic encephalopathy were enrolled in this study. Patients were divided into two groups i.e. Group-A (Probiotics) and Group-B (Placebo). There were 19(63.3%) males and 11(36.7%) females in group-A, while 21(70.0%) were males and 9(30.0%) females in group-B. The age range was from 16 to 75 years with a mean age of 52.1±16.29 years. The mean age of patients in group A was 56.9±14.8 years and in group-B was 45.9±10.4 years. In group-A, mean serum ammonia at baseline was 77.90±10.46 μmol/L and 82.73±8.44 μmol/L in group-B with a p-value 0.054. In group-A, the mean change in serum ammonia was 19.26±11.49 μmol/L and 7.13±6.48 μmol/L in group-B with a p-value 0.000005. Conclusion: Probiotics are better as compared to control in reducing serum ammonia levels in hepatic encephalopathy.

Keywords: Hepatic Encephalopathy, Liver Cirrhosis, Serum Ammonia.