Effect of Probiotics on elastographic findings of patients with nonalcoholic fatty liver disease

Abstract

Given the widespread prevalence of obesity and its associated complications, such as non-alcoholic fatty liver disease (NAFLD), which can progress to liver failure and hepatocellular carcinoma, coupled with the limited efficacy of nutritional and behavioral modification methods for weight loss and the absence of specific treatments for NAFLD, there exists a notable gap in understanding the impact of probiotics on NAFLD. Consequently, our study aims to explore the effects of probiotics on patients diagnosed with NAFLD, specifically evaluating its impact based on elastography findings. Materials and Methods: Our study adopts a double-blind randomized clinical trial design. Patients diagnosed with NAFLD via ultrasound examination were recruited from Imam Reza hospital. Elastography was performed to assess liver stiffness, fibrosis severity, and steatosis degree based on Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) criteria. Subsequently, patients were randomly allocated into either the control or intervention group through block randomization. The intervention group received rifaximin 550 mg tablets twice daily for one week, followed by probiotic capsules containing a blend of Lactobacillus rhamnosus, Bifidobacterium lactis, Lactobacillus casei, Bifidobacterium Brue, Lactobacillus acidophilus, Bifidobacterium longum, Lactobacillus plantarum, Bifidobacterium bifidum, and Streptococcus thermophilus, each at a dosage of 10^9 colony-forming units (CFU) twice daily for six months. The control group received a placebo in addition to their standard treatments. After six months, elastography was repeated, and changes in liver steatosis and fibrosis were assessed. Results: Following the intervention, the control group exhibited no statistically significant changes. Conversely, the intervention group demonstrated a significant increase in individuals categorized as F0-F1 (P=0.027) and a significant decrease in those categorized as F2-F3 (P=0.033) compared to baseline. Furthermore, intergroup analysis revealed that the intervention group had a significantly higher proportion of individuals classified as F0-F1 based on LSM (P=0.031) and a significantly lower proportion classified as F2-F3 based on LSM (P=0.033) compared to the control group.