Efficacy of Probiotic Therapy in Preventing Overt Hepatic Encephalopathy

Background: Hepatic encephalopathy (HE) is common and is characterized by several neuropsychiatric symptoms ranging from mild impairments in cognitive function to coma, experienced by cirrhotic patients. Advanced encephalopathy or overt hepatic encephalopathy is associated with poor outcomes including increased mortality, but consequences of reduced physical and mental function as well as reductions in quality of life can be just as devastating. The cost of hepatic encephalopathy for the healthcare system is exorbitant. While therapies exist for severe encephalopathy, increasingly researchers are aiming to prevent clinically overt hepatic encephalopathy. There is growing interest in the use of probiotic products, which have an excellent physiological basis to reduce the absorption of ammonia, a key neurotoxin in precipitating encephalopathy. The present review discusses hepatic encephalopathy, the various classifications, and reviews literature for probiotics studying the effects on preventing severe encephalopathy. We subsequently postulate on the potential studies and strategies for research studies moving forward. AUTHOR CONFLICT OF INTEREST STATEMENT AND INFORMATION The authors declare no conflict of interest 1Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada. 2 Lawson Health Research Institute, London, Ontario, Canada. 3Department of Surgery, Schulich School of Medicine, Western University. 4Program of Experimental Medicine, Western University Department of Medicine. 5 Department of Microbiology and Immunology, Western University Corresponding Author Adam Rahman MD MSc (EPID) FRCPC Assistant Professor of Medicine Division of Gastroenterology, Western University adam.rahman@sjhc.london.on.ca 268 Grosvenor St. London, Ontario, N6A 4V2 Room B0-689, St. Joseph's Health Centre © Rahman et. al. This is an open access journal distributed under the terms of the Creative Common License BY NC