In the Journals

Multistrain probiotic improves cognitive complications in cirrhosis

Intake of a multistrain probiotic improved cognitive function, risk for falls and inflammatory response in patients with cirrhosis and a history of cognitive impairment and previous falls, according to a study published in Hepatology Communications.

“In addition to their negative consequences for the patient, falls have implications for the patient’s relatives and are an economic and social burden for the community,” Eva Román, of the department of gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, wrote. “Moreover, individuals with previous falls are frequently predisposed to recurrent falling, thus supporting the growing concept of frailty in patients with cirrhosis and the need for preventive measures.”

Román and colleagues also explained that probiotics can modulate gut microbiota, the intestinal barrier and the immune response, which can not only improve liver function and complications such as bacterial infections but also “ameliorate cognitive dysfunction and avoid its consequences, such as overt hepatic encephalopathy, traffic accidents, deterioration of health-related quality of life.”

The researchers randomly assigned 36 patients equally between the probiotic group and a placebo group. Patients in the probiotic group received the eight-strain De Simone Formulation (Visbiome) at a total dose of 450 billion live bacteria per 4.4 g sachet with maltose and silicon dioxide as excipients.

At the end of 12 weeks, patients in the probiotic group demonstrated the following improvements from baseline compared with no changes in the placebo group:

  • Cognitive function by Psychometric Hepatic Encephalopathy Score (1.29 vs. 0.35; P = .006);
  • Timed Up and Go test (11.38 vs. 10 seconds; P = .015);
  • Gait speed (0.9 vs. 1.12 m/second; P = .02); and
  • Serum C-reactive protein (7.62 vs. 3.45 mg/L; P = .01).

Additionally, patients in the probiotic group had a decrease in fatty acid-binding protein 6 (P = .009) and urinary claudin-3 (P = .002) compared with no changes in the placebo group. While it did not meet statistical significance, there was a numerically lower incidence of falls in the probiotic group compared with placebo (0 vs. 4).

There were no study-related adverse events and overall adherence was 97.2% in the probiotic group and 94.4% in the placebo group.

“As future research, a study with a larger number of patients and with a longer treatment protocol is warranted to assess the usefulness of the probiotic in decreasing the incidence of falls,” Román and colleagues concluded. “Moreover, it would be interesting to analyze the intimate mechanisms determining the improvement in the risk for falls through accurate neurological tests and MRI-based techniques as well as the changes in the microbiota function after probiotic treatment.” – by Talitha Bennett

Disclosure: Román reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

Editor’s note: This article has been updated to reflect the specific product used in this study.

Intake of a multistrain probiotic improved cognitive function, risk for falls and inflammatory response in patients with cirrhosis and a history of cognitive impairment and previous falls, according to a study published in Hepatology Communications.

“In addition to their negative consequences for the patient, falls have implications for the patient’s relatives and are an economic and social burden for the community,” Eva Román, of the department of gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, wrote. “Moreover, individuals with previous falls are frequently predisposed to recurrent falling, thus supporting the growing concept of frailty in patients with cirrhosis and the need for preventive measures.”

Román and colleagues also explained that probiotics can modulate gut microbiota, the intestinal barrier and the immune response, which can not only improve liver function and complications such as bacterial infections but also “ameliorate cognitive dysfunction and avoid its consequences, such as overt hepatic encephalopathy, traffic accidents, deterioration of health-related quality of life.”

The researchers randomly assigned 36 patients equally between the probiotic group and a placebo group. Patients in the probiotic group received the eight-strain De Simone Formulation (Visbiome) at a total dose of 450 billion live bacteria per 4.4 g sachet with maltose and silicon dioxide as excipients.

At the end of 12 weeks, patients in the probiotic group demonstrated the following improvements from baseline compared with no changes in the placebo group:

  • Cognitive function by Psychometric Hepatic Encephalopathy Score (1.29 vs. 0.35; P = .006);
  • Timed Up and Go test (11.38 vs. 10 seconds; P = .015);
  • Gait speed (0.9 vs. 1.12 m/second; P = .02); and
  • Serum C-reactive protein (7.62 vs. 3.45 mg/L; P = .01).

Additionally, patients in the probiotic group had a decrease in fatty acid-binding protein 6 (P = .009) and urinary claudin-3 (P = .002) compared with no changes in the placebo group. While it did not meet statistical significance, there was a numerically lower incidence of falls in the probiotic group compared with placebo (0 vs. 4).

There were no study-related adverse events and overall adherence was 97.2% in the probiotic group and 94.4% in the placebo group.

“As future research, a study with a larger number of patients and with a longer treatment protocol is warranted to assess the usefulness of the probiotic in decreasing the incidence of falls,” Román and colleagues concluded. “Moreover, it would be interesting to analyze the intimate mechanisms determining the improvement in the risk for falls through accurate neurological tests and MRI-based techniques as well as the changes in the microbiota function after probiotic treatment.” – by Talitha Bennett

Disclosure: Román reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

Editor’s note: This article has been updated to reflect the specific product used in this study.