EFFECT OF PROBIOTICS ON CLINICAL IMPROVEMENT IN PATIENTS WITH HEPATIC ENCEPHALOPATHY: A PRE-POST INTERVENTIONAL STUDY AT A SHEIKH ZAYED HOSPITAL LAHORE

Abstract

Background: Hepatic encephalopathy (HE) is a potentially reversible neuropsychiatric complication of advanced liver disease, particularly liver cirrhosis. Increased ammonia production, intestinal dysbiosis, and impaired gut-barrier function contribute to neurological and cognitive dysfunction. Probiotics may improve HE by restoring intestinal microbial balance and reducing the production and absorption of ammonia and other neurotoxins.

Objective: To evaluate the effectiveness of probiotic therapy in improving clinical severity and reducing serum ammonia levels in patients with hepatic encephalopathy.

Methods: Patients diagnosed with hepatic encephalopathy who met the predefined eligibility criteria were enrolled after informed consent. Baseline demographic information, clinical history, encephalopathy grade, neurological findings, and serum ammonia levels were recorded. Participants received probiotic therapy alongside standard medical management for four weeks. Clinical status was monitored using a standardized grading system based on consciousness, orientation, behavior, cognition, and neuromuscular signs such as asterixis. At the end of the intervention, clinical grading and serum ammonia measurements were repeated and compared with baseline findings. Appropriate statistical methods were used to assess pre- and post-treatment changes.

Results: After four weeks of probiotic supplementation, patients demonstrated improvement in hepatic encephalopathy severity. Improvements included better orientation and cognitive performance, reduced confusion, and decreased asterixis. Several patients shifted from moderate to milder grades of encephalopathy, while some experienced resolution of neurological manifestations. Serum ammonia levels also decreased following treatment, indicating a favourable biochemical response.

Conclusion: Probiotics may provide a safe, well-tolerated, and cost-effective adjunct to conventional therapy for hepatic encephalopathy. Their beneficial effects may result from modulation of gut microbiota, reduced intestinal ammonia production, and improved gut-barrier function. Larger randomized controlled trials with longer follow-up periods are required to confirm these findings and establish standardized probiotic treatment regimens.