Probiotics for the Prevention of Major Complications of Cirrhosis
Probiotics for the Prevention of Major Complications of Cirrhosis
The purpose of this study is to determine whether probiotics are effective in the prevention
 of the complications of liver cirrhosis.
Colonic bacteria clearly play a major role in the pathogenesis of major complications in
 patients with liver cirrhosis. By producing ammonia and endotoxins they can cause hepatic
 encephalopathy , and their translocation from the gut to the peritoneal cavity is the major
 mechanism for spontaneous bacterial peritonitis. There are also new studies suggesting a
 possible connection between bacterial translocation and bleeding from esophageal varices.
 Some of the therapeutic measures for the treatment and prevention of complications in
 cirrhotic patients, such as antibiotics and lactulose, are partially directed against gut
 bacteria.

 In recent years there is a growing interest in the effect of probiotic bacteria on gut flora
 and prevention of infection. They were found to prevent pediatric infectious diarrhea and
 antibiotic-associated diarrhea- especially those caused by Clostridium difficile.

 The probiotic bacteria, among which the most common are the lactose fermenting Lactobacilli,
 inhibit the growth of pathogenic bacteria by acidifying the gut lumen, competing for
 nutrients, and by producing antimicrobial substances. They adhere to the gut mucosa and by
 that are thought to prevent bacterial translocation from the gut. These effects of probiotics
 raised the idea that they may have a role in the treatment and prevention of cirrhosis
 complications. A recent study examined the effect of probiotics on patients with minimal
 chronic hepatic encephalopathy. Hepatic encephalopathy was reversed in 50% of the patients
 receiving probiotics. These patients also demonstrated a significant reduction of blood
 levels of ammonia, bilirubin and ALT, and of pathologic bacteria in stool cultures. This
 study showed promising results but was carried out on a relatively small population.
 Furthermore, the effect of probiotics on the prevention of hepatic encephalopathy and other
 major complications of cirrhosis has not been studied yet. Therefore, more studies are needed
 to establish the role of probiotics in patients with cirrhosis.
Inclusion Criteria:

 Patients with liver cirrhosis with at least one of the followings

 1)Major complication of cirrhosis in the past (including variceal bleeding, encephalopathy
 and SBP) 2)Evidence for portal hypertension 3)Reduced hepatic synthetic function

 -

 Exclusion Criteria:

 1. Patients with alcoholic cirrhosis who still consume alcohol

 2. Patients that are chronically treated with antibiotics or lactulose -