 We have recently completed an open-label uncontrolled trial of the probiotic VSL3 in 8 patients with compensated cirrhosis and evidence of portal hypertension VIP study to determine whether this agent would have beneficial effects in portal pressure reduction unpublished data Tandon, P. et al.. The open label design and the inclusion of compensated Child Pugh A cirrhotic patients in this initial study were chosen to confirm the safety and tolerance of VSL3 and the safety of the portal pressure measurements at our center. No changes of physical status occured. There was a non-significant reduction in portal pressure from 19.7 to 18.1 mm Hg after 2 months of VSL3 supplementation. Furthermore, there was a significant reduction in the serum aldosterone level p0.03. IL-8 levels were reduced in 46 patients analyzed to date. These results suggest that VSL3 results in cytokine reduction and an improvement in the effective circulating volume even in these well-compensated cirrhotic patients. The comparison of the rest of the pro-inflammatory mediators and stool microflora is still being analyzed. 