Meta-analysis of probiotics efficacy in the treatment of minimum hepatic encephalopathy

Objective

This study aims to systematically evaluate the efficacy of probiotics in treating minimum hepatic encephalopathy (MHE).

Methods

A systematic search was conducted across three major databases: PubMed, China National Knowledge Infrastructure and Wanfang. The search period spanned from the inception of each database to 9 March 2023. The objective was to identify all randomised controlled trials (RCTs) examining the efficacy of probiotic preparations in treating MHE. The search terms included ‘probiotics’ along with other clinically relevant terms to comprehensively capture all pertinent studies.

Results

A total of 18 RCTs were included. The meta-analysis showed that probiotic treatment outperformed control groups in reducing blood ammonia levels (standard mean difference [MD] = −2.68, 95% confidence interval [CI]: −3.90 to −1.46, p < .0001), improving the remission rate of MHE (risk ratio [RR] = 2.79, 95% CI: 1.23–6.35, p = .01) and lowering alanine aminotransferase levels (MD = −11.10, 95% CI: −16.17 to −6.03, p < .0001). It also significantly reduced the Model for End-Stage Liver Disease scores (MD = −2.55, 95% CI: −3.56 to −1.54, p < .00001) and the incidence of MHE (RR = .18, 95% CI: .09–.34, p < .00001).

Conclusion

Our study demonstrates that probiotics effectively improve blood ammonia levels, liver function and cognitive function in patients with MHE. They significantly enhance the remission rate of MHE and effectively reduce its incidence, providing solid new evidence for treating MHE with probiotics.