As part of AP&T’s peer-review process, a technical check of this meta-analysis was performed by Dr P. Collins.
Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy
Article first published online: 20 JAN 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 6, pages 662–671, March 2011
How to Cite
Shukla, S., Shukla, A., Mehboob, S. and Guha, S. (2011), Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy. Alimentary Pharmacology & Therapeutics, 33: 662–671. doi: 10.1111/j.1365-2036.2010.04574.x
- Issue published online: 14 FEB 2011
- Article first published online: 20 JAN 2011
- Publication data Submitted 18 November 2010 First decision 6 December 2010 Resubmitted 28 December 2010 Accepted 28 December 2010 EV Pub Online 20 January 2011
Aliment Pharmacol Ther 2011; 33: 662–671
Background Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE.
Aim To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials.
Methods MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association.
Results Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32–0.50; P < 0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24–0.47; P < 0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26–0.65; P < 0.0001 and RR of 0.51, 95% CI 0.32–0.80; P = 0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose.
Conclusions The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics.