The effect of Probiotic and Zinc combination therapy for the prevention of recurrence of Hepatic encephalopathy (secondary prophylaxis) in cirrhosis patients

Abstract

Introduction: Hepatic encephalopathy (HE) is a debilitating and often progressive condition involving neuropsychiatric complications associated with decompensated liver disease.For several decades, maintenance therapy with lactulose has been considered the standard of care, but emerging data from clinical trials demonstrate that other therapeutic options may be available and could have a better tolerability profile than lactulose.The small, yet significant, improvements in HRQOL and Quality of sleep and HE exacerbations demonstrated in different trials make zinc and probiotic combination therapy an attractive option for management of HE in patient with decompensated liver cirrhosis.Objective: The effect of probiotic and zinc combination therapy for the prevention of HE in patient with decompensated cirrhosis.Method: This study was conducted as a randomized clinical trial. 45 patients with decompensated cirrhosis were enrolled. Patients were randomly assigned into 3groups; Control group: consists of 15 patients receiving Lactulose everyday for 3 months. First Intervention group: consists of 15 patients receiving Probiotic and Lactulose everyday for 3 months. Second intervention group: consists of 15 patients receiving Probiotic, Zinc Gluconate and Lactulose everyday for 3 months.Results: 3 months after intervention, HRQOL improved significantly in the B and C groups vs control group. There was no significant difference between These two groups for parameters of HRQOL. Also a significant improvement of quality of sleep assessed by the PSQI was only seen in the C group.But there was no significant reduction in venouse Ammonia level and MELD score, after 3 months between three groups. And also no significant difference observed in preventing of overt HE between three groups. Conclusion: probiotic and zinc combination therapy was significantly effective in improvement of HRQOL and quality of sleep, but it was as equally effective as other groups in prevention of overt HE and reduction of venouse Ammonia level.