Fructans, Lactitol and Lactose in Minimal Hepatic Encephalopathy
Fructans, Lactitol and Lactose in Minimal Hepatic Encephalopathy
As an alternative for the treatment of Minimal Hepatic Encephalopathy (MHE) Agave fructans
 have shown prebiotic effects, and have shown to improve function of the digestive system,
 control and induce glycemic effect satiety. Therefore the impact of the fermentation of such
 prebiotic in the gut may contribute to improving health and quality of life of patients with
 MHE.
Hepatic encephalopathy (HE) is a potentially reversible neuropsychiatric syndrome
 characterized by changes in cognitive function, behavior and personality of patients with
 chronic liver disease or cirrhosis. Increased concentration of ammonia is the main
 precipitant of encephalopathy and brain astrocytes are the main affected cells in the
 neuropathology of this disease. The toxicity of ammonia together with the neutrophil
 dysfunction and oxidative stress and inflammation secondary to infection, result in a
 progressive decline in quality of life and an increased risk of accidents for patients with
 this disease.

 About 28% of patients with liver cirrhosis develop encephalopathy during the course of the
 disease and within this percentage, 84% will develop MHE. Currently, chronic liver diseases
 are the third leading cause of death in Mexico. The high prevalence suggests that HE could
 become a public health problem, with the 2020 projected figures of 1.5 million people with
 cirrhosis, which represents approximately 400 000 to 500 000 people with probable
 encephalopathy.

 The usual treatment of MHE is the use of antibiotics or pro and prebiotics, these enhances
 the performance and quality of life of patients who have the disease. The general consensus
 has been using lactulose or lactitol as the first treatment options for MHE consistent with
 data from previous studies. However, the rate of adherence to treatment with lactulose and
 lactitol is low, especially in patients with MHE with no symptoms and lack of specific
 information about their problems, to adhere to medications that can cause diarrhea and
 flatulence.

 In the last eight years functional ingredients have been studied as alternatives to the
 treatment of patients with MHE. In 2004, Liu et al showed that 25% chicory inulin (prebiotic)
 and this combined with probiotics improve the psychometric function of MHE patients. In
 similar studies conducted in 2007 and 2009 in which they used a formulation with a symbiotic
 fructo-oligosaccharides based chicory inulin and B. longum, showed improvement in
 psychometric tests applied to patients. In 2008, Bajaj et al showed that patients who
 consumed a yogurt with probiotics, showed significant changes in the degree of MHE.

 As an alternative for treating the MHE we found Agave tequilana Weber fructans, which present
 prebiotic effect, besides having shown to improve the function of the digestive system,
 control and induce glycemic effect satiety. Therefore the impact of the fermentation of such
 prebiotic in the gut may contribute to improving the health and quality of life of patients
 with MHE.
Inclusion Criteria:

 -  Aged 18 to 70 years.

 -  Liver cirrhosis of any etiology.

 -  Presence of minimal hepatic encephalopathy.

 -  Presence of hepatic encephalopathy I

 Exclusion Criteria:

 -  Hepatic encephalopathy II or III

 -  Use of antibiotics in the previous month.

 -  Presence of immunological diseases.

 -  Consumption of probiotics.

 -  Patients with hepato-renal diseases.

 -  Patients who do not agree to participate in the project.