title: Bifidobacterium longum with Fructo-Oligosaccharides in Patients with Non Alcoholic Steatohepatitis Effect of microbial cell preparation on renal profile and liver function among type 2 diabetics: a randomized controlled trial Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Probiotics for patients with compensated liver cirrhosis: a double-blind placebo-controlled study. Safety assessment of Bacillus subtilis CU1 for use as a probiotic in humans Safety and tolerance of Lactobacillus reuteri supplementation to a population infected with the human immunodeficiency virus. Decrease of aminotransferase levels in obese women is related to body weight reduction, irrespective of type of diet. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Probiotic supplementation for respiratory and gastrointestinal illness symptoms in healthy physically active individuals. Effects of probiotics (cultured Lactobacillus subtilis/Streptococcus faecium) in the treatment of alcoholic hepatitis: randomized-controlled multicenter study Probiotic strain Bacillus subtilis CU1 stimulates immune system of elderly during common infectious disease period: a randomized, double-blind placebo-controlled study Treatment of nonalcoholic steatohepatitis with probiotics. A proof-of-concept study. Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Probiotic Yogurt Effects on Intestinal Flora of Patients with Chronic Liver Disease Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study. An open-label randomized controlled trial of lactulose and probiotics in the treatment of minimal hepatic encephalopathy Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. Short-term probiotic therapy alleviates small intestinal bacterial overgrowth, but does not improve intestinal permeability in chronic liver disease
abstract: Background Increased exposure to intestinal bacterial products may contribute to the pathogenesis of non alcoholic steatohepatitis ( NASH ) . Bifidobacteria are predominant bacterial species in the human gut microbiota and have been considered to exert a beneficial effect on human health by maintaining the equilibrium of the resident microbiota . Aims To evaluate the effects of Bifidobacterium longum with fructo-oligosaccharides ( Fos ) in the treatment of NASH . Methods A total of 66 patients were r and omly and equally divided into two groups receiving Bifidobacterium longum with Fos and lifestyle modification ( i.e. , diet and exercise ) versus lifestyle modification alone . The following variables were assessed at −4 ( beginning of the dietary lead-in period ) , 0 ( r and omization ) , 6 , 12 , 18 , and 24 weeks : aspartate transaminase ( AST ) , alanine transaminase ( ALT ) , bilirubin , albumin , total cholesterol , high-density lipoprotein ( HDL ) cholesterol , low-density lipoprotein ( LDL ) cholesterol , triglycerides , fasting plasma glucose , insulin , C-peptide , C-reactive protein ( CRP ) , tumor necrosis factor (TNF)-α , homeostasis model assessment of insulin resistance ( HOMA-IR ) , and serum endotoxins . Liver biopsies were performed at entry and repeated after 24 weeks of treatment . Results At the end of study period , we observed that the Bifidobacterium longum with Fos and lifestyle modification group versus the lifestyle modification alone group showed significant differences in the AST −69.6 versus −45.9 IU/mL ( P < 0.05 ) , LDL cholesterol −0.84 versus −0.18 mmol/L ( P < 0.001 ) , CRP −2.9 versus −0.7 mg/L ( P < 0.05 ) , TNF-α −0.45 versus −0.12 ng/mL ( P < 0.001 ) , HOMA-IR −1.1 versus −0.6 ( P < 0.001 ) , serum endotoxin −45.2 versus −30.6 pg/mL ( P < 0.001 ) , steatosis ( P < 0.05 ) , and the NASH activity index ( P < 0.05 ) . Conclusions Bifidobacterium longum with Fos and lifestyle modification , when compared to lifestyle modification alone , significantly reduces TNF-α , CRP , serum AST levels , HOMA-IR , serum endotoxin , steatosis , and the NASH activity index Background The beneficial effect of probiotics on renal profile and liver function has been reported among patients with chronic kidney disease and fatty liver respectively . However , its effect on renal profile and liver function among type 2 diabetic individuals has not been fully understood . To investigate the effect of microbial cell preparation on renal profile and liver function tests among type 2 diabetic individuals . Methods A r and omized , double-blind , parallel-group , controlled clinical trial was conducted on a total of 136 type 2 diabetics age 30 - 70 years old in a teaching hospital in Kuala Lumpur , Malaysia . Subjects were r and omly assigned to receive microbial cell preparation ( N = 68 ) or a placebo ( N = 68 ) for 12 weeks . The outcomes measured at baseline , week 6 , and week 12 and included changes in renal profile ( Sodium , Potassium , Urea , Creatinine , Glomerular Filtration Rate ) , and liver function tests ( Albumin , Total Protein , Alkaline Phosphatase , Alanine Aminotransferase , Aspartate Aminotransferase ) . Intention to treat ( ITT ) analysis was performed on all the recruited subjects , while per protocol ( PP ) analysis was conducted on those who completed the trial with good compliance . Result The urea levels significantly declined in the probiotic group . Serum urea levels reduced from 4.26 mmol/L to 4.04 mmol/L in Probiotic Group while it increased in Placebo Group from 4.03 mmol/L to 4.24 mmol/L. These changes were significant between groups in ITT analysis ( p = 0.018 ) . Other parameters did not change significantly between groups . Conclusion 12 weeks supplementation with daily dosage of 6 × 1010 Colony Forming Units of multi-strain microbial cell preparation significantly improved urea levels . Trial registration ( Clinical trials : # NCT01752803 BACKGROUND Nonalcoholic fatty liver disease ( NAFLD ) is the most common chronic liver disease in the world . Oral administration of synbiotic has been proposed as an effective treatment of NAFLD because of its modulating effect on the gut flora , which can influence the gut-liver axis . OBJECTIVE The objective was to evaluate the effects of supplementation with synbiotic on hepatic fibrosis , liver enzymes , and inflammatory markers in patients with NAFLD . DESIGN In a r and omized , double-blind , placebo-controlled clinical trial conducted as a pilot study , 52 patients with NAFLD were supplemented twice daily for 28 wk with either a synbiotic or a placebo capsule . Both groups were advised to follow an energy-balanced diet and physical activity recommendations . RESULTS At the end of the study , the alanine aminotransferase ( ALT ) concentration decreased in both groups ; this reduction was significantly greater in the synbiotic group . At the end of the study , the following significant differences [ means ( 95 % CIs ) ] were seen between the synbiotic and placebo groups , respectively : ALT [ -25.1 ( -26.2 , -24 ) compared with -7.29 ( -9.5 , -5.1 ) IU/L ; P < 0.001 ] , aspartate aminotransferase [ -31.33 ( -32.1 , -30.5 ) compared with -7.94 ( -11.1 , -4.8 ) IU/L ; P < 0.001 ] , γ-glutamyltransferase [ -15.08 ( -15.5 , -14.7 ) compared with -5.21 ( -6.6 , -3.9 ) IU/L ; P < 0.001 ] , high-sensitivity C-reactive protein [ -2.3 ( -3 , -1.5 ) compared with -1.04 ( -1.5 , -0.6 ) mmol/L ; P < 0.05 ] , tumor necrosis factor-α [ -1.4 ( -1.7 , -1.1 ) compared with -0.59 ( -0.8 , -0.3 ) mmol/L ; P < 0.001 ] , total nuclear factor κ-B p65 [ -0.016 ( -0.022 , -0.011 ) compared with 0.001 ( -0.004 , -0.007 ) mmol/L ; P < 0.001 ] , and fibrosis score as determined by transient elastography [ - 2.98 ( -3.6 , -2.37 ) compared with -0.77 ( -1.32 , -0.22 ) kPa ; P < 0.001 ] . CONCLUSIONS Synbiotic supplementation in addition to lifestyle modification is superior to lifestyle modification alone for the treatment of NAFLD , at least partially through attenuation of inflammatory markers in the body . Whether these effects will be sustained with longer treatment duration s remains to be determined BACKGROUND Gut flora is related to the major complications of liver cirrhosis including hepatic encephalopathy , spontaneous bacterial peritonitis , and variceal bleeding . Prior studies have reported a beneficial effect of gut flora modification with probiotic bacteria in patients with minimal hepatic encephalopathy . We aim ed to study the effect of probiotics on clinical and laboratory parameters of patients with compensated cirrhosis . METHODS A double-blind placebo-controlled study that included patients with liver cirrhosis and at least one major complication of cirrhosis in the past , clinical evidence of portal hypertension , or decreased hepatic synthetic function . Participants were r and omly assigned to receive probiotic capsules containing Lactobacillus acidophilus , Lactobacillus bulgaricus , Bifidobacterium lactis , and Streptococcus thermophiles or placebo for a period of 6 mo . RESULTS A total of 36 patients were available for final analysis ( distributed equally between the probiotic and placebo groups ) . The administration of probiotics was not associated with significant differences in either clinical or laboratory parameters between the two groups . Because the lack of a beneficial effect may be related to the compensated liver disease of patients , we conducted a sub analysis of patients with baseline ammonia levels > 50 mmol/L. In this subgroup , the administration of probiotics appeared to significantly reduce the ammonia levels starting after 1 mo of treatment . However , this effect diminished and lost its significance following comparison to the placebo group . CONCLUSIONS Our study did not show a significant beneficial effect of probiotic supplementation in patients with compensated liver cirrhosis . Nevertheless , it points toward a possible positive effect of probiotics in patients with above normal baseline ammonia levels . This issue requires further investigation in larger cohorts Abstract Bacillus subtilis CU1 is a recently described probiotic strain with beneficial effects on  immune health in elderly subjects . The following work describes a series of studies supporting the safety of the strain for use as an ingredient in food and supplement preparations . Using a combination of 16S rDNA and gyrB nucleotide analyses , the species was identified as a member of the Bacillus subtilis complex ( B. subtilis subsp . spizizenii ) . Further characterization of the organism at the strain level was achieved using r and om amplified polymorphic DNA polymerase chain reaction ( RAPD PCR ) and pulsed field gel electrophoresis ( PFGE ) analyses . B. subtilis CU1 did not demonstrate antibiotic resistance greater than existing regulatory cutoffs against clinical ly important antibiotics , did not induce hemolysis or produce surfactant factors , and was absent of toxigenic activity in vitro . Use of B. subtilis CU1 as a probiotic has recently been evaluated in a 16‐week r and omized , double‐blind , placebo‐controlled , parallel‐arm study , in which 2 × 109 spores per day of B. subtilis CU1 were administered for a total 40 days to healthy elderly subjects ( 4 consumption periods of 10 days separated by 18‐day washouts ) . This work describes safety related endpoints not previously reported . B. subtilis CU1 was safe and well‐tolerated in the clinical subjects without undesirable physiological effects on markers of liver and kidney function , complete blood counts , hemodynamic parameters , and vital signs . HighlightsA safety assessment of the probiotic Bacillus subtilis CU1 was conducted . Genomic analyses identified the species as a member of the B. subtilis complex . Antibiotic resistance was not observed at levels exceeding regulatory cut‐offs . B. subtilis CU1 was absent of toxigenic activity in vitro . B. subtilis CU1 was safely consumed ( 2 × 109 spores/day ) by all clinical subjects Probiotic supplementation may provide health benefits , especially for individuals with an underlying disease state that makes them more susceptible to infections . The purpose of this experiment was to evaluate the safety and tolerance of Lactobacillus reuteri ingestion by subjects infected with the human immunodeficiency virus ( HIV ) . Thirty-nine subjects consumed a freeze-dried preparation of L. reuteri or a placebo for 21 days in a double-masked , parallel design experiment . Serum chemistry , haematology , immune profile , urinalysis , physical examination , gastrointestinal tolerance and faecal microbiota data were collected . No clinical ly significant changes were noted in any of the safety parameters measured . Overall , tolerance was good in both groups . Consumption of L. reuteri tended to increase faecal levels of L. reuteri on days 7 , 14 and 21 of treatment feeding ( P < 0.06 , P < 0.11 and P = 0.05 , respectively ) . However , faecal levels of L. reuteri and total Lactobacillus species were lower than levels previously observed in healthy male adults . Overall , this study documents that L. reuteri may be fed to HIV-positive individuals at 1 x 10(10 ) colony forming units/day without any clinical ly significant safety or tolerance problems OBJECTIVE To evaluate the efficacy of low carbohydrate diet ( LCD ) as compared with low fat diet ( LFD ) to decrease aminotransferase levels in obese women with nonalcoholic fatty liver disease . MATERIAL AND METHODS A total of 59 women were r and omly enrolled in a non-controlled clinical intervention study to receive either LCD or LFD during six months . Apparently healthy non-pregnant obese women aged 20 to 65 years were eligible to participate . Previous diagnosis of hepatic disease , serum creatinine level ≥ 1.5 mg/dL , severe life-limiting medical illness , pregnancy , active participation in other dietary program , use of weight loss drugs , or alcohol consumption ≥ 30 g per day were exclusion criteria . RESULTS A total of 31 obese women who received LCD were compared with 28 women allocated in the LFD group . There were 3 ( LCD group ) and 2 ( LFD group ) women with lost of follow-up . No differences in the proportion of type 2 diabetes , hypertension and hyperlipidemia were noted between women in the LCD and LFD groups . At end of follow-up , there were not significant statistical differences in the anthropometric and biochemical characteristics between women in both groups . The weight loss was 5.7 and 5.5 % for women in the LCD LFD groups . Although the decrease of AST ( 31.7 and 22.4 % ) and ALT ( 41 and 33.3 % ) levels was more elevated in the women of LCD group , as compared with the LFD group , there were not significant statistical differences . CONCLUSIONS Our results show that weight loss , irrespective of the type of diet , reduces aminotransferase levels in obese women with NAFLD Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND & AIMS To examine the effect of supplementation with probiotics on respiratory and gastrointestinal illness in healthy active men and women . METHODS A r and omised double-blind placebo-controlled trial was conducted . Four hundred and sixty five participants ( 241 males ; age 35 ± 12 y ( mean ± SD ) and 224 females ; age 36 ± 12 y ) were assigned to one of three groups : Group 1 - Bifidobacterium animalis subsp . lactis Bl-04 ( Bl-04 ) 2.0 × 10(9)colony forming units per day , CFU per day , Group 2 - Lactobacillus acidophilus NCFM and Bifidobacterium animalis subsp . lactis Bi-07 ( NCFM & Bi-07 ) 5 × 10(9 ) CFU each per day ) or Group 3 - placebo mixed in a drink . RESULTS The risk of an upper respiratory illness episode was significantly lower in the Bl-04 group ( hazard ratio 0.73 ; 95 % confidence interval 0.55 - 0.95 ; P = 0.022 ) compared to placebo . There was no significant difference in illness risk between the NCFM & Bi-07 group ( hazard ratio 0.81 ; 0.62 - 1.08 ; P = 0.15 ) and the placebo group . There was a 0.7 and 0.9 month delay in the median time to an illness episode in the Bl-04 and NCFM & Bi-07 groups respectively compared to placebo ( placebo 2.5 months ; Bl-04 3.2 months ; NCFM & Bi-07 3.4 months ) . There were insufficient GI illness episodes for analysis . The NCFM & Bi-07 group but not the Bl-04 group undertook significantly more physical activity ( 8.5 % ; 6.7%-10 % ; P < 0.003 ) than the placebo group . CONCLUSION The probiotic Bl-04 appears to be a useful nutritional supplement in reducing the risk of URTI in healthy physically-active adults . TRIAL REGISTRATION Australia New Zeal and Clinical Trials Registry : Number ACTRN12611000130965 Background Probiotics might reduce gut-derived microbial lipopolysaccharide ( LPS ) by restoring bowel flora in patients with alcoholic hepatitis ( AH ) . We evaluated the therapeutic effects of probiotics in patients with AH . Patients and methods Between September 2010 and April 2012 , 117 patients ( probiotics 60 and placebo 57 ) were prospect ively r and omized to receive the 7 days of cultured Lactobacillus subtilis/Streptococcus faecium ( 1500 mg/day ) or placebo .  All patients were hospitalized and were not permitted to consume alcohol for the 7 days of the study . Liver function test , proinflammatory cytokines , LPS , and colony-forming units by stool culture were examined and compared after therapy . Results In both groups , the mean levels of aspartate aminotransferase/alanine aminotransferase , alkaline phosphatase , & ggr;-glutamyl transpeptidase , bilirubin , and prothrombin time were significantly improved after 7 days of abstinence . In the probiotics group ( baseline and after ) , albumin ( 3.5±0.7 and 3.7±0.6 g/dl , P=0.038 ) and tumor necrosis factor-&agr ; ( 121±244 and 71±123 pg/ml , P=0.047 ) showed differences . In addition , the number of colony-forming units of Escherichia coli was significantly reduced ( 435±287 and 168±210 , P=0.002 ) . In the placebo group , the level of LPS ( 1.7±2.8 and 2.0±2.7 EU/ml ) was significantly increased . In the intergroup comparison , significant differences in the levels of tumor necrosis factor-&agr ; ( P=0.042 ) and LPS ( P=0.028 ) were observed between the groups . Conclusion Immediate abstinence is the most important treatment for patients with AH . In addition , 7 days of oral supplementation with cultured L. subtilis/S. faecium was associated with restoration of bowel flora and improvement of LPS in patients with AH Background Bacillus probiotics health benefits have been until now quite poorly studied in the elderly population . This study aim ed to assess the effects of Bacillus subtilis CU1 consumption on immune stimulation and resistance to common infectious disease ( CID ) episodes in healthy free-living seniors . Results One hundred subjects aged 60–74 were included in this r and omized , double-blind , placebo-controlled , parallel-arms study . Subjects consumed either the placebo or the probiotic ( 2.109B . subtilis CU1 spores daily ) by short periodical courses of 10 days intermittently , alternating 18-day course of break . This scheme was repeated 4 times during the study . Symptoms of gastrointestinal and upper/lower respiratory tract infections were recorded daily by the subjects throughout the study ( 4 months ) . Blood , saliva and stool sample s were collected in a predefined subset of the first forty-four subjects enrolled in the study .  B. subtilis CU1 supplementation did not statistically significantly decrease the mean number of days of reported CID symptoms over the 4-month of study ( probiotic group : 5.1 ( 7.0 ) d , placebo group : 6.6 ( 7.3 ) d , P = 0.2015 ) . However , in the subset of forty-four r and omized subjects providing biological sample s , we showed that consumption of B. subtilis CU1 significantly increased fecal and salivary secretory IgA concentrations compared to the placebo . A post-hoc analysis on this subset showed a decreased frequency of respiratory infections in the probiotc group compared to the placebo group . Conclusion Taken together , our study provides evidence that B. subtilis CU1 supplementation during the winter period may be a safe effective way to stimulate immune responses in elderly subjects BACKGROUND Probiotics have profound effect on nonalcoholic steatohepatitis ( NASH ) in animal models . We aim ed to test the hypothesis that probiotics treatment was superior to usual care in reducing liver fat in NASH patients . MATERIAL AND METHODS Patients with histology-proven NASH were r and omized to receive probiotics ( n = 10 ) or usual care ( n = 10 ) for 6 months . The Lepicol probiotic formula contained Lactobacillus plantarum , Lactobacillus deslbrueckii , Lactobacillus acidophilus , Lactobacillus rhamnosus and Bifidobacterium bifidum . The primary endpoint was change in intrahepatic triglyceride content ( IHTG ) , as measured by proton-magnetic resonance spectroscopy , from baseline to month 6 . Secondary endpoints included changes in liver biochemistry and metabolic profile . RESULTS IHTG decreased from 22.6 ± 8.2 % to 14.9 ± 7.0 % in the probiotic group ( P = 0.034 ) but remained static in the usual care group ( 16.9 ± 6.1 % to 16.0 ± 6.6 % ; P = 0.55 ) . Six subjects in the probiotic group had IHTG reduced by more than 30 % from baseline , compared to 2 subjects in the usual care group ( P = 0.17 ) . The probiotic group also had greater reduction in serum aspartate aminotransferase level ( P = 0.008 ) . On the other h and , the use of probiotics was not associated with changes in body mass index , waist circumference , glucose and lipid levels . CONCLUSIONS Probiotics treatment may reduce liver fat and AST level in NASH patients . The therapeutic potential of probiotics in NASH should be tested in larger studies Minimal hepatic encephalopathy ( MHE ) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis . Treatment with lactulose is of benefit . The possible role of synbiotics ( probiotics and fermentable fiber ) has not been assessed . We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials . MHE , defined by abnormality on at least one test modality , was present in 58 ( 60 % ) patients . Fifty-five of these patients with MHE were r and omized to receive a synbiotic preparation ( n = 20 ) , fermentable fiber alone ( n = 20 ) , or placebo ( n = 15 ) for 30 days . Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology , with significant fecal overgrowth of potentially pathogenic Escherichia coli and Staphylococcal species . Synbiotic treatment significantly increased the fecal content of non-urease-producing Lactobacillus species at the expense of these other bacterial species . Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50 % of patients . Synbiotic treatment was also associated with a significant reduction in endotoxemia . The Child-Turcotte-Pugh functional class improved in nearly 50 % of cases . Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients . In conclusion , treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis Background : Patients with chronic liver disease generally have intestinal flora imbalance that is related to the development and worsening of the disease . Objective : The purpose of this study was to evaluate the effects of probiotic yogurt on intestinal flora of patients with chronic liver disease . Methods : A r and omized controlled trial , pretest-posttest control group design , was used . Patients were r and omized to an experimental group ( 41 patients ) or a control group ( 40 patients ) . Patients in the experimental group were given probiotic yogurt ( one cup each time , three times per day for 14 days ) containing Bacillus bifidus , Lactobacillus acidophilus , Lactobacillus bulgaricus , and Streptococcus thermophilus within 2 hours after meals .  Levels of fecal flora , symptoms and signs , and laboratory examination indexes were collected . Results : After intervention , the experimental group had a lower Escherichia coli count and reduced intestinal flora imbalance ( p < .05 ) . Comparison of the experimental and control groups after the intervention showed that the former had improved symptoms and signs , including significant improvement in debilitation , food intake , appetite , abdominal distension , and ascitic fluid ( p < .05 ) . Conclusion : Probiotic yogurt reduces the levels of intestinal flora imbalance and has an additional therapeutic effect on patients with chronic liver disease The effects of chronic alcohol consumption on the bowel flora and the potential therapeutic role of probiotics in alcohol-induced liver injury have not previously been evaluated . In this study , 66 adult Russian males admitted to a psychiatric hospital with a diagnosis of alcoholic psychosis were enrolled in a prospect i ve , r and omized , clinical trial to study the effects of alcohol and probiotics on the bowel flora and alcohol-induced liver injury . Patients were r and omized to receive 5 days of Bifidobacterium bifidum and Lactobacillus plantarum 8PA3 versus st and ard therapy alone ( abstinence plus vitamins ) . Stool cultures and liver enzymes were performed at baseline and again after therapy . Results were compared between groups and with 24 healthy , matched controls who did not consume alcohol . Compared to healthy controls , alcoholic patients had significantly reduced numbers of bifidobacteria ( 6.3 vs. 7.5 log colony-forming unit [CFU]/g ) , lactobacilli ( 3.15 vs. 4.59 log CFU/g ) , and enterococci ( 4.43 vs. 5.5 log CFU/g ) . The mean baseline alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , and gamma-glutamyl transpeptidase ( GGT ) activities were significantly elevated in the alcoholic group compared to the healthy control group ( AST : 104.1 vs. 29.15 U/L ; ALT : 50.49 vs. 22.96 U/L ; GGT 161.5 vs. 51.88 U/L ) , indicating that these patients did have mild alcohol-induced liver injury . After 5 days of probiotic therapy , alcoholic patients had significantly increased numbers of both bifidobacteria ( 7.9 vs. 6.81 log CFU/g ) and lactobacilli ( 4.2 vs. 3.2 log CFU/g ) compared to the st and ard therapy arm . Despite similar values at study initiation , patients treated with probiotics had significantly lower AST and ALT activity at the end of treatment than those treated with st and ard therapy alone ( AST : 54.67 vs. 76.43 U/L ; ALT 36.69 vs. 51.26 U/L ) . In a subgroup of 26 subjects with well-characterized mild alcoholic hepatitis ( defined as AST and ALT greater than 30 U/L with AST-to-ALT ratio greater than one ) , probiotic therapy was associated with a significant end of treatment reduction in ALT , AST , GGT , lactate dehydrogenase , and total bilirubin . In this subgroup , there was a significant end of treatment mean ALT reduction in the probiotic arm versus the st and ard therapy arm . In conclusion , patients with alcohol-induced liver injury have altered bowel flora compared to healthy controls . Short-term oral supplementation with B. bifidum and L. plantarum 8PA3 was associated with restoration of the bowel flora and greater improvement in alcohol-induced liver injury than st and ard therapy alone Background and aim Minimal hepatic encephalopathy ( MHE ) is associated with poor quality of life and increased work disability . Treatment with lactulose and probiotics has shown some benefit . We compared lactulose with probiotics and a combination of lactulose plus probiotics in the treatment of MHE . Patients and methods One hundred and ninety cirrhotic patients without overt encephalopathy [ Child 's A grade 71 patients ( 37.4 % ) , Child 's B grade 72 patients ( 37.9 % ) , Child 's C grade 47 patients ( 24.7 % ) ] were evaluated by psychometry ( number connection tests A and B or figure connection tests A and B ) and P300 auditory event-related potential ( P300ERP ) . MHE was diagnosed by abnormal psychometry and /or P300ERP . Patients were r and omized to receive lactulose [ group A ( n=35 ) : dose 30–60 ml/day ] , probiotics [ group B ( n=35 ) : dose 1 capsule three times/day , each capsule contained Streptococcus faecalis 60 million , Clostridium butyricum 4 million , Bacillus mesentricus 2 million , lactic acid bacillus 100 million ] and lactulose plus probiotics [ group C ( n=35 ) ] for 1 month . Response was defined by normalization of the abnormal test parameters . Results MHE was diagnosed in 105 ( 55.2 % ) patients . Of the 105 patients , 75 ( 71 % ) had both abnormal psychometry and P300ERP , whereas 90 ( 86 % ) had abnormal psychometry alone , and 89 patients ( 85 % ) had abnormal P300ERP alone . Significant improvement was seen in abnormal psychometry tests ( group A : n=31 vs. n=12 , group B : n=29 vs. n=14 , group C : n=30 vs. n=10 ) , P300ERP ( group A : 376.8±22.3 vs. 344.3±30.6 ms , group B : 385.4±28.5 vs. 355.5±27.9 ms , group C : 387.7±27.5 vs. 347.7±31.5 ms ) and venous ammonia levels ( group A : 102.3±63.1 vs. 69.3±33.3 μmol/l , group B : 108.2±37.5 vs. 75.7±33.0 μmol/l , group C : 96.3±27.7 vs. 68.7±28.4 μmol/l ) in lactulose , probiotics and a combination of lactulose plus probiotics groups after treatment . Normalization of abnormal psychometry and P300ERP was seen in 54.8 , 51.6 and 56.6 % of patients treated with lactulose , probiotics and lactulose plus probiotics groups , respectively . Conclusion A total of 55 % of the patients with cirrhosis had MHE . Lactulose or probiotics or combinations of both are equally effective in the treatment of MHE OBJECTIVE The present pilot trial was carried out to evaluate the effects of an acute treatment with a mixture containing 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus per day in patients with non alcoholic fatty liver disease ( NAFLD ) . RESEARCH METHODS A sample of 30 patients with NAFLD ( diagnosed by liver biopsy ) was enrolled and 28 patients were analyzed in a double blind r and omized clinical trial . Patients were r and omized to one of the following treatments during 3 months : group I , treated with one tablet per day with 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus and group II , treated with one placebo tablet ( 120 mg of starch ) . RESULTS In group I , alanine amino transferase ( ALT : 67.7 + /- 25.1 vs. 60.4 + /- 30.4 UI/L ; p < 0.05 ) , aspartate aminotransferase activity ( AST : 41.3 + /- 15.5 vs. 35.6 + /- 10.4 UI/L ; p < 0.05 ) and gammaglutamine transferase levels ( gammaGT : 118.2 + /- 63.1 vs. 107.7 + /- 60.8 UI/L ; p < 0.05 ) decreased . In group II , all liver function parameters remained unchanged ( ALT : 60.7 + /- 32.1 vs. 64.8 + /- 35.5 UI/L ; p < 0.05 ) , aspartate aminotransferase activity ( AST : 31.7 + /- 13.1 vs. 36.4 + /- 13.8 UI/L ; ns ) and gammaglutamine transferase levels ( gammaGT : 82.1 + /- 55.1 vs. 83.6 + /- 65.3 UI/L ; ns ) . Anthropometric parameters and cardiovascular risk factors remained unchanged after treatment in both groups . CONCLUSION A tablet of 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus , with a r and omized clinical design , improved liver aminotransferases levels in patients with NAFLD Aim : Although numerous animal studies suggest that probiotic therapy has beneficial effects in various liver diseases , the evidence for beneficial effects in human liver disease is controversial . This study was carried out to investigate the efficacy of probiotic therapy in alleviating small intestinal bacterial overgrowth ( SIBO ) and permeability in chronic liver disease . Methods : Fifty-three patients with chronic liver disease were r and omized to either probiotic therapy or placebo . Six bacterial species were used : Bifidobacterium bifidum , Bifidobacterium lactis , Bifidobacterium longum , Lactobacillus acidophilus , Lactobacillus rhamnosus , and Streptococcus thermophilus . After 4 weeks , changes in the composition of fecal bacteria , SIBO , intestinal permeability , and clinical symptoms were examined . Results : Three of the six probiotic species , B. lactis , L. rhamnosus , and L. acidophilus , increased in the feces of the probiotic therapy group ( P<0.001 ) , whereas there was no change in fecal microbiota in the placebo group . SIBO disappeared in many individuals of the probiotic therapy group , but none in the placebo ( 24 vs. 0 % , P<0.05 ) . General gastrointestinal symptoms also improved more in the probiotic group and improvement in intestinal permeability was slightly but not significantly more frequent in the probiotic arm than the placebo arm ( 50 vs. 31.3 % , P=0.248 ) . Numbers of lactobacilli in stool were correlated negatively with intestinal permeability ( P for trend<0.05 ) . Liver chemistry did not improve significantly in either group . Conclusions : We conclude that short-term probiotic administration in chronic liver disease is effective in alleviating SIBO and clinical symptoms , but ineffective in improving intestinal permeability and liver function
target: Subgroup analysis suggested the existence of liver disease at baseline , synbiotics supplementation and duration of supplementation ≥ 8 weeks result ed in more pronounced improvement in liver function enzymes than their counterparts .
  Conclusions Probiotics and synbiotics may be suggested as supplements to improve serum concentration of liver enzymes , especially when synbiotics administered for a period ≥ 8 weeks and in individuals with liver disease
background: Purpose The gut – liver interaction suggests that modification of gut bacterial flora using probiotics and synbiotics may improve liver function .
  This systematic review and meta- analysis aim ed to clarify the effect of probiotics and synbiotics consumption on the serum concentration of liver function enzymes .