Therapeutic Potential of Probiotics –Lactobacillus Plantarum UBLP40 and Bacillus Clausii UBBC07 on Thioacetamide-Induced Acute Hepatic Encephalopathy in Rats

Purpose: Hepatic encephalopathy (HE) or hepatic coma is an onerous, not utterly understood complication accompanying both acute and chronic liver dysfunction and/ or presence of portosystemic shunting. In HE, hyperammonemia and inflammatory responses are believed to act in synergism. Probiotics, Lactobacillus plantarum UBLP40 and Bacillus clausii UBBC07 reduce small intestinal bacterial overgrowth and hyperammonemia, thereby preventing the development of HE. Methods: The effect of probiotics-Lactobacillus plantarum UBLP40 (107CFU/day, 14 days) and Bacillus clausiiUBBC07 (107CFU/day, 14 days) combination and standard drug-lactulose (2.5 ml/kg in 3 divided doses, 14 days) was studied in thioacetamide (250mg/kg for 3 days) induced acute HE in rats by measuring behavioural parameters, biochemical parameters (serum AST, ALT, ALP and ammonia level), neurochemical parameters and histopathology study in brain and liver. Results: In contrast to only thioacetamide treated rats, probiotics treatment substantially (p<0.001) reduced liver function parameters i.e. serum AST, ALT, ALP, and ammonia, improved behaviour parameters, i.e. decreased motor disruption, improved memory impairment. Probiotics treated rats have also shown a substantial improvement in parameters of oxidative stress, i.e. decreased lipid peroxidation and increased glutathione level in brain tissue and ameliorate the histopathological changes induced by thioacetamide in brain and liver.Conclusions: It can be concluded based on the findings that the combination therapy of Lactobacillus plantarum UBLP40 and Bacillus clausiiUBBC07 proves to be effective in acute hepatic encephalopathy in the preclinical stage and further studies are required to assess this therapy potential in the clinical stage.

Lactulose versus lactitol in acute hepatic encephalopathy (HE).

Hepatic encephalopathy (HE), a syndrome observed in some patients with cirrhosis, with depressed level of consciousness. Lactulose as well as lactitol has been used in the treatment of HE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects and better tolerated. However, literature showed equal efficacy of both drugs. So we conducted this trial to find better drug to implement its use in future. Objective: To compare the effectiveness of lactulose and lactitol in patients with acute hepatic encephalopathy. Study Design: Randomized Controlled Trial. Setting: Department of Medicine OPD and Emergency (East, West, North, South), Mayo Hospital, Lahore. Period: 6 Months June 2017 to Dec 2017. Material & Methods: 570 patients were included through non-probability, consecutive sampling after informed consent. Initial grade of HE was assessed and patients were randomly divided in two groups by using lottery method i.e. lactulose or lactitol. Patients were admitted to ward for management and kept under observation for 5 days. After 5 days, HE grades was measured again, then improvement in grade of HE (effectiveness) was measured. All data was entered and analyzed by using SPSS version 21.0. Chi-square was applied to compare both groups for effectiveness taking p-value≤0.05 as significant. Results: In this study the mean age of the patients was 44.22 ±11.81 years, the male to female ratio of the patients was 2.4:1. The mean duration of the cirrhosis of the patients was 3.73±1.61 months. In our study the effectiveness was achieved in 538 (94.39%) patients, out of which 263 cases were from lactulose group and 275 were from lactitol group and the difference was significant (p<0.0.5). Conclusion: Our study results concluded that Lactitol is better choice for the treatment of patients with acute hepatic encephalopathy as compared to lactulose. More efficacy was achieved in lactitol group patients than in lactulose group patients.