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Jayakumar, Saumya; Carbonneau, Michelle; Hotte, Naomi; Befus, A. Dean; St. Laurent, Chris; Owen, Richard; McCarthy, Mairin; Madsen, Karen; Bailey, Robert J.; Ma, Mang; Bain, Vince; Rioux, Kevin; Tandon, Puneeta

VSL#3® probiotic therapy does not reduce portal pressures in patients with decompensated cirrhosis

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  • Medientyp: E-Artikel
  • Titel: VSL#3® probiotic therapy does not reduce portal pressures in patients with decompensated cirrhosis
  • Beteiligte: Jayakumar, Saumya; Carbonneau, Michelle; Hotte, Naomi; Befus, A. Dean; St. Laurent, Chris; Owen, Richard; McCarthy, Mairin; Madsen, Karen; Bailey, Robert J.; Ma, Mang; Bain, Vince; Rioux, Kevin; Tandon, Puneeta
  • Erschienen: Wiley, 2013
  • Erschienen in: Liver International, 33 (2013) 10, Seite 1470-1477
  • Sprache: Englisch
  • DOI: 10.1111/liv.12280
  • ISSN: 1478-3223; 1478-3231
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background &amp; Aims</jats:title><jats:p>In patients with decompensated cirrhosis, bacterial translocation can contribute to splanchnic vasodilatation, decreased effective circulating volume, and portal hypertension. The primary objective of this randomized, double blind placebo controlled trial was to evaluate the effect of the probiotic <jats:styled-content style="fixed-case">VSL</jats:styled-content>#3<jats:sup>®</jats:sup> on the hepatic venous pressure gradient (<jats:styled-content style="fixed-case">HVPG</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Seventeen patients with decompensated cirrhosis and an <jats:styled-content style="fixed-case">HVPG</jats:styled-content> of ≥10 mmHg were randomized to receive 2 months of <jats:styled-content style="fixed-case">VSL</jats:styled-content>#3<jats:sup>®</jats:sup> or an identical placebo. <jats:styled-content style="fixed-case">HVPG</jats:styled-content>, endotoxin, interleukin (<jats:styled-content style="fixed-case">IL</jats:styled-content>)‐6, <jats:styled-content style="fixed-case">IL</jats:styled-content>‐8, <jats:styled-content style="fixed-case">IL</jats:styled-content>‐10, renin, aldosterone, nitric oxide and stool microbiota were measured at baseline and study end.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Two of the 17 patients were taken off the trial before completion (one for alcohol abuse and the second for <jats:styled-content style="fixed-case">SBP</jats:styled-content> – both in placebo arm). Data were analysed on the remaining 15 patients. The median model for end‐stage liver disease score was 12, and 80% of patients had Child Pugh B disease. The treatment arm had a greater decrease in <jats:styled-content style="fixed-case">HVPG</jats:styled-content> from baseline to study end than the placebo arm (median change from baseline −11.6% vs +2.8%), although this reduction was not statistically significant in either group. There was a significant reduction in the plasma aldosterone level in the <jats:styled-content style="fixed-case">VSL</jats:styled-content>#3<jats:sup>®</jats:sup> group, but no significant changes in the other measured parameters, including the stool microflora analysis.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Within the limitations of our sample size, <jats:styled-content style="fixed-case">VSL</jats:styled-content>#3<jats:sup>®</jats:sup> therapy does not appear to have a significant impact on portal pressure reduction in patients with decompensated cirrhosis.</jats:p></jats:sec>