VSL#3® probiotic therapy does not reduce portal pressures in patients with decompensated cirrhosis. (23rd August 2013)

• Record Type: Journal Article
• Authors: Jayakumar, Saumya; Carbonneau, Michelle; Hotte, Naomi; Befus, A. Dean; St. Laurent, Chris; Owen, Richard; McCarthy, Mairin; Madsen, Karen; Bailey, Robert J.; Ma, Mang; Bain, Vince; Rioux, Kevin; Tandon, Puneeta
• Is Part Of: Liver international. Volume 33:Number 10(2013:Nov.)
• Page Start: 1470
• Page End: 1477
• Publication Date: 2013-08-23
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12280
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12280-abs-0001"> <title>Abstract</title> <sec id="liv12280-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>In patients with decompensated cirrhosis, bacterial translocation can contribute to splanchnic vasodilatation, decreased effective circulating volume, and portal hypertension. The primary objective of this randomized, double blind placebo controlled trial was to evaluate the effect of the probiotic VSL#3<sup>®</sup> on the hepatic venous pressure gradient (HVPG).</p> </sec> <sec id="liv12280-sec-0002" sec-type="section"> <title>Methods</title> <p>Seventeen patients with decompensated cirrhosis and an HVPG of ≥10 mmHg were randomized to receive 2 months of VSL#3<sup>®</sup> or an identical placebo. HVPG, endotoxin, interleukin (IL)‐6, IL‐8, IL‐10, renin, aldosterone, nitric oxide and stool microbiota were measured at baseline and study end.</p> </sec> <sec id="liv12280-sec-0003" sec-type="section"> <title>Results</title> <p>Two of the 17 patients were taken off the trial before completion (one for alcohol abuse and the second for SBP – both in placebo arm). Data were analysed on the remaining 15 patients. The median model for end‐stage liver disease score was 12, and 80% of patients had Child Pugh B disease. The treatment arm had a greater decrease in HVPG from baseline to study end than the placebo arm (median change from baseline −11.6% vs +2.8%), although this reduction was not statistically significant in either group. There was a significant reduction in the plasma aldosterone level in the VSL#3<sup>®</sup> group, but no significant changes in the other measured parameters, including the stool microflora analysis.</p> </sec> <sec id="liv12280-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Within the limitations of our sample size, VSL#3<sup>®</sup> therapy does not appear to have a significant impact on portal pressure reduction in patients with decompensated cirrhosis.</p> </sec> </abstract>