Randomized clinical trial: Effects of multi-species probiotics on small intestinal bacterial overgrowth in patients with chronic liver disease- a placebo controlled study

Abstract

Background: This study was conducted to investigate the effi - cacy of probiotics administration in alleviating SIBO and intestinal permeability in chronic liver disease. Methods: Fifty three patients with chronic liver disease were randomized to receive either probiotics or placebo. After 4 weeks, the changes in SIBO, intestinal permeability and clinical symptoms were examined and compared. The lactulose-based hydrogen breath test was conducted to identify SIBO. The intestinal permeability was assessed by comparing the absorbability of lactulose and mannitol. The changes in digestive symptoms, composition of fecal bacteria, and liver function were also compared after four weeks of administration. Results: The positive rate of SIBO was 26% in chronic liver disease patients. After four weeks later, in the probiotics group, 24% of patients showed improvement of SIBO, but in placebo group, there was no patient whose SIBO was improved and 16% showed aggravation of SIBO (P<0.05). The treatment group showed significant increase in the level of fecal B. lactis, L. rhamnosus, and L. acidophilus (P<0.05). Although probiotics also contained B. bifidum, B. longum, and S. thermophiles, the changes in the levels of B. bifidum, B. longum, and S. thermophilus were not significant. By contrast, there were no significant changes in the levels of the ingested bacteria in the placebo group. About half of treatment and 31.3% of placebo group reported improvement in intestinal permeability, the difference between two groups was statistically insignificant (P=0.248). Improvement in abdominal pain of the probiotics and placebo group was 3.17±1.6 and 1.95±2.4 respectively (P=0.056) while improvement in gastrointestinal symptoms of the probiotics and placebo group was 3.35±1.7 and 2.05±2.3 respectively, suggesting that digestive symptoms of the probiotics group improved compared to placebo (P=0.047). Conclusions: 4 weeks probiotics administration in chronic liver disease patients was effective in alleviating SIBO and clini- cal symptoms but ineffective in improving intestinal permeability and liver function.