Probiotics for hepatic encephalopathy

Hepatic encephalopathy is a frequent and disabling complication in patients with cirrhosis. Some probiotics can help to prevent episodes of hepatic encephalopathy through intestinal microbiota modulation, decreasing ammonemia, and improving the proinflammatory state that is typical of cirrhosis. The aim of this update was to review the articles evaluating probiotics in the field of hepatic encephalopathy. We reviewed the evidence for the efficacy of probiotics in hepatic encephalopathy, from both experimental and clinical studies. Experimental studies have shown that some probiotics reduced gut dysbiosis, strengthened the intestinal barrier, reduced bacterial translocation as well as systemic inflammation and neuroinflammation, and improved the neurometabolic profile and behavior of animals. Clinical studies have confirmed the improvement of gut dysbiosis and a proinflammatory state, as well as a reduction of ammonemia in patients with cirrhosis. These studies have shown a clinical benefit: reduced incidence of the first episode and recurrence of hepatic encephalopathy, improved cognitive function and health-related quality of life, and decreased risk of falls. In conclusion, the efficacy of probiotics in the prevention and treatment of hepatic encephalopathy in patients with cirrhosis should be confirmed by more extensive randomized studies. These studies should determine how to position probiotics in the treatment strategy alongside proven treatments and fecal transplantation.