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Intestinal microflora in patients with liver cirrhosis


Correspondence to: Hai Ying ZHAO, Department of Gastroenterology, Beijing Friendship Hospital Affiliated to Capital University of Medical Sciences, Beijing 100050, China. Email:


OBJECTIVE:  Patients with liver cirrhosis have varying degrees of imbalance of the intestinal flora and probiotics can improve some of the symptoms of gastrointestinal dysfunction in these patients. In the present study, blood ammonia, fecal pH, fecal ammonia, and plasma endotoxin were measured after administration of two kinds of probiotics in order to detect the changes in intestinal flora.

METHODS:  Six bacteria and yeast were cultured and the colony forming units were counted. Fifty cirrhotic patients were randomized to receive probiotic capsules containing Bifidobacterium, Lactobacillus acidophilus and Enterococcus, or probiotic capsules containing Bacillus subtilis and Enterococcus faecium for 14 days. Fecal flora, pH and ammonia, blood ammonia (detected by test paper) and plasma endotoxin (detected by LAL test kits) were measured before and after the treatment.

RESULTS:  Patients with liver cirrhosis had varying degrees of imbalance of the intestinal flora as shown by a decrease in the Bifidobacterium count (10.04 ± 0.78 vs 9.48 ± 1.13, P < 0.05). The severity of the imbalance was matched by that of liver dysfunction, with the most serious imbalance observed in Child-Pugh C patients. Both types of probiotic increased the Bifidobacterium count (9.46 ± 1.09 vs 10.30 ± 1.11, 9.81 ± 0.62 vs 10.44 ± 1.08, respectively, P < 0.05) and reduced the levels of fecal pH and fecal and blood ammonia (P < 0.05). Probiotics containing B. subtilis and E. faecium reduced the level of endotoxin in cirrhotic patients with endotoxemia (0.0876 ± 0.0117 Eu/mL vs 0.0685 ± 0.0246 Eu/mL, P < 0.05).

CONCLUSIONS:  Patients with liver cirrhosis have an imbalance of intestinal bacteria flora. Probiotics effectively increased the Bifidobacterium count and reduced the level of fecal pH and fecal and blood ammonia.