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Effects of probiotic therapy on portal pressure in patients with cirrhosis: a pilot study
Author(s) -
Tandon Puneeta,
Moncrief Karli,
Madsen Karen,
Arrieta Marie C.,
Owen Richard J.,
Bain Vince G.,
Wong Winnie W.,
Ma Mang M.
Publication year - 2009
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2009.02020.x
Subject(s) - medicine , cirrhosis , portal venous pressure , spontaneous bacterial peritonitis , aldosterone , portal hypertension , gastroenterology , plasma renin activity , blood pressure , renin–angiotensin system
Abstract Background: Recent literature has supported the role of bacterial translocation as a mediator of splanchnic vasodilatation and portal hypertension. The objective of this study was to determine whether the probiotic VSL#3 would reduce portal pressure in patients with cirrhosis. Methods: Eight patients with compensated or very early decompensated cirrhosis and hepatic venous pressure gradient (HVPG) >10 mmHg, received 2 months of VSL#3 (3600 billion bacteria daily). The HVPG, intestinal permeability, endotoxin, tumour necrosis factor (TNF)‐α, interleukin (IL)‐6, IL‐8, renin and aldosterone were measured at baseline and study end. Results: There was no change in the HVPG or intestinal permeability from baseline to study end but there was a trend to reduction in plasma endotoxin ( P =0.09), a mild but significant increase in serum TNF‐α ( P =0.02) and a significant reduction in plasma aldosterone ( P =0.03). Conclusions: Within the limitations of small sample size, there does not appear to be a benefit of probiotic therapy for portal pressure reduction in patients with compensated or early decompensated cirrhosis. The reductions in endotoxin and aldosterone suggest possible beneficial effects of probiotics for this patient population. The clinical significance of the small but unexpected increase in TNF‐α is unclear. Future studies are planned in patients with decompensated cirrhosis.