Kurtovic, J.; Ruettimann, U.; Adamson, H.; Bihari, D.; Bengmark, S.; Williams, R.; Riordan, S.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA3
Academic Journal
Background: Intervention aimed at reducing intestinal levels of endotoxin containing Gram-negative bacteria is reported to improve systemic haemodynamic disturbance in cirrhosis. Any beneficial effect on hepatic blood flow is unknown. This study addressed this issue. Methods: We studied 15 cirrhotic patients (hepatitis C virus, n = 7; alcohol, n = 6; primary biliary cirrhosis, n = 1; idiopathic, n = 1; Child-Pugh grade A, n = 6; B, n = 5; C, n = 4) and 11 patients with chronic hepatitis (hepatitis C, n = 9; hepatitis B, n = 1; non-alcoholic steatohepatitis, n = 1). Indocyanine green retention at 15 min (ICGR15) following an intravenous bolus of 0.5 mg/kg body weight was assessed as an index of hepatic blood flow, using a non-invasive transcutaneous system (LiMon, Pulsion, Germany). ICGR15 was measured at baseline and following oral supplementation for 7 days with a synbiotic (probiotic and Fermentable fibre) preparation including Lactobacillus plantarum 2362, L paracasei subsp paracasei 19, Pediacoccus pentoseceus 5-33:3, and L raffinolactis 32-77:1, designed to increase the intestinal content of Gram-positive bacteria (Synbiotic 2000, Medipharm, Sweden). Results: ICGR15 was significantly higher in cirrhotic patients (median 38.3, range 5.0-60%) than those with chronic hepatitis (median 5.3, range 1.8-9.7%) (p < 0.0005). Supplementation with the synbiotic regimen was associated with a significant reduction in ICGR15 in the cirrhotic group (p = 0.003). ICGR15 was reduced by a median 17.5% (range 1.4-65%) of baseline values in 14/15 (93%) such patients and increased by 4.1% in the other patient. Treatment led to no significant change in ICGR15 in patients with chronic hepatitis (p = 0.65). Conclusions: Use of a Gram-positive synbiotic preparation significantly improves ICG clearance in cirrhotic patients, presumably by reversing a disturbance in gut flora occurring in cirrhosis but not chronic hepatitis that adversely affects hepatic blood flow.


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