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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 2
Mar.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(2): 331-335

Role of probiotics in primary prevention of esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.02.017

  • Department of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

  • Received Date: 2020-08-10
  • Accepted Date: 2020-09-01
  • Published Date: 2021-02-20
    Abstract
  •   Objective  To investigate the effect of probiotics on the risk of esophagogastric variceal bleeding (EVB) within 1 year in cirrhotic patients with gastroesophageal varices.  Methods  A retrospective analysis was performed for the clinical data of 692 cirrhotic patients with gastroesophageal varices who were hospitalized in Beijing Ditan Hospital, Capital Medical University, from February 2008 to February 2017 and were followed up for more than 1 year. Among these patients, 346 patients who received probiotics during the 1-year follow-up were enrolled as probiotics cohort (probiotics group), and then, by using the 1:1 propensity score method, 346 patients who did not receive probiotics treatment were enrolled as non-probiotics group after adjustment for Child-Pugh class, degree of varices, and red color sign. All patients were managed according to the primary prevention strategy recommended by related guidelines, and in addition, the patients in the probiotics group were given probiotic therapy. The incidence rate of EVB within 1 year was compared between the two groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate backward Cox regression analyses were used to screen out the influencing factors for EVB. The Kaplan-Meier analysis was used to investigate the cumulative incidence rate of EVB in both groups, and the log-rank test was used for comparison.  Results  Probiotic therapy was an independent protective factor against EVB in cirrhotic patients (adjusted hazard ratio=0.510, 95% confidence interval: 0.299-0.870, P=0.013). A total of 61 patients experienced EVB during the 1-year follow-up, with 23 patients in the probiotics group and 38 in the non-probiotics group, and the probiotics group had a significantly lower cumulative incidence rate of EVB within 1 year than the non-probiotics group (6.6% vs 11.0%, χ2=4.045, P=0.042). The probiotics group had a significantly longer median time from baseline to the occurrence of EVB than the non-probiotics group [137.0 (85.0-258.0) days vs 123.0(72.5-206.5) days, Z=-1.101, P=0.271].  Conclusion  Probiotics can effectively reduce the incidence rate of EVB within 1 year in cirrhotic patients with gastroesophageal varices, with a tendency to delay the occurrence of bleeding events.

     

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    • References(25)
  • [1]
    KUMAR A, SHARMA P, ARORA A. A new prognostic algorithm based on stage of cirrhosis and hvpg to improve risk-stratification after variceal bleeding[J]. Hepatology, 2020.[Epub ahead of print].
    [2]
    HAQ I, TRIPATHI D. Recent advances in the management of variceal bleeding[J]. Gastroenterol Rep (Oxf), 2017, 5(2): 113-126. DOI: 10.1093/gastro/gox007
    [3]
    SHUKLA R, KRAMER J, CAO Y, et al. Risk and predictors of variceal bleeding in cirrhosis patients receiving primary prophylaxis with non-selective beta-blockers[J]. Am J Gastroenterol, 2016, 111(12): 1778-1787. DOI: 10.1038/ajg.2016.440
    [4]
    O'BRIEN J, TRIANTOS C, BURROUGHS AK. Management of varices in patients with cirrhosis[J]. Nat Rev Gastroenterol Hepatol, 2013, 10(7): 402-412. DOI: 10.1038/nrgastro.2013.51
    [5]
    HOLSTER IL, TJWA ET, MOELKER A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + β-blocker for prevention of variceal rebleeding[J]. Hepatology, 2016, 63(2): 581-589. DOI: 10.1002/hep.28318
    [6]
    Chinese Society of Spleen And Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition)[J]. Chin J Surg, 2019, 57(12): 885-892. (in Chinese)

    中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华外科杂志, 2019, 57(12): 885-892.
    [7]
    REVERTER E, TANDON P, AUGUSTIN S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding[J]. Gastroenterology, 2014, 146(2): 412-419. DOI: 10.1053/j.gastro.2013.10.018
    [8]
    BETRAPALLY NS, GILLEVET PM, BAJAJ JS. Gut microbiome and liver disease[J]. Transl Res, 2017, 179: 49-59. DOI: 10.1016/j.trsl.2016.07.005
    [9]
    ALBILLOS A, de LA HERA A, GONZÁLEZ M, et al. Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement[J]. Hepatology, 2003, 37(1): 208-217. DOI: 10.1053/jhep.2003.50038
    [10]
    QUAN M, XING HC. Research progress on intestinal flora and chronic liver diseases[J/CD]. Chin J Liver Dis (Electronic Version), 2019, 11(3): 26-30. (in Chinese)

    全敏, 邢卉春. 肠道菌群与慢性肝病相关研究进展[J/CD]. 中国肝脏病杂志(电子版), 2019, 11(3): 26-30.
    [11]
    SAAB S, SURAWEERA D, AU J, et al. Probiotics are helpful in hepatic encephalopathy: A meta-analysis of randomized trials[J]. Liver Int, 2016, 36(7): 986-993. DOI: 10.1111/liv.13005
    [12]
    ZHOU LP, LIU SZ. Effect of probiotics in the prevention of spontaneous bacterial peritonitis in patients with cirrhosis[J]. Chin J Mod Drug Appl, 2013, 7(10): 6-7. (in Chinese) DOI: 10.3969/j.issn.1673-9523.2013.10.004

    周立平, 刘尚忠. 益生菌在肝硬化自发性腹膜炎中的预防效果[J]. 中国现代药物应用, 2013, 7(10): 6-7. DOI: 10.3969/j.issn.1673-9523.2013.10.004
    [13]
    GARCIA-TSAO G, SANYAL AJ, GRACE ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J]. Hepatology, 2007, 46(3): 922-938. DOI: 10.1002/hep.21907
    [14]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2016.02.002

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002
    [15]
    WIEST R, ALBILLOS A, TRAUNER M, et al. Targeting the gut-liver axis in liver disease[J]. J Hepatol, 2017, 67(5): 1084-1103. DOI: 10.1016/j.jhep.2017.05.007
    [16]
    MORATALLA A, GÓMEZ-HURTADO I, SANTACRUZ A, et al. Protective effect of Bifidobacterium pseudocatenulatum CECT7765 against induced bacterial antigen translocation in experimental cirrhosis[J]. Liver Int, 2014, 34(6): 850-858. DOI: 10.1111/liv.12380
    [17]
    CAPLAN MS, MILLER-CATCHPOLE R, KAUP S, et al. Bifidobacterial supplementation reduces the incidence of necrotizing enterocolitis in a neonatal rat model[J]. Gastroenterology, 1999, 117(3): 577-583. DOI: 10.1016/S0016-5085(99)70450-6
    [18]
    RUSELER-van EMBDEN JG, van LIESHOUT LM, GOSSELINK MJ, et al. Inability of Lactobacillus casei strain GG, L. acidophilus, and Bifidobacterium bifidum to degrade intestinal mucus glycoproteins[J]. Scand J Gastroenterol, 1995, 30(7): 675-680. DOI: 10.3109/00365529509096312
    [19]
    SCHIFFRIN EJ, ROCHAT F, LINK-AMSTER H, et al. Immunomodulation of human blood cells following the ingestion of lactic acid bacteria[J]. J Dairy Sci, 1995, 78(3): 491-497. DOI: 10.3168/jds.S0022-0302(95)76659-0
    [20]
    BERNET MF, BRASSART D, NEESER JR, et al. Lactobacillus acidophilus LA 1 binds to cultured human intestinal cell lines and inhibits cell attachment and cell invasion by enterovirulent bacteria[J]. Gut, 1994, 35(4): 483-489. DOI: 10.1136/gut.35.4.483
    [21]
    QUAN M, XING HC. Progress on Lactobacillus and liver diseases[J/CD]. Chin J Exp Clin Infect Dis (Electronic Edition), 2019, 13(6): 467-471. (in Chinese)

    全敏, 邢卉春. 乳酸杆菌与肝病研究进展[J/CD]. 中华实验和临床感染病杂志(电子版), 2019, 13(6): 467-471.
    [22]
    de SANTIS A, FAMULARO G, de SIMONE C. Probiotics for the hemodynamic alterations of patients with liver cirrhosis[J]. Am J Gastroenterol, 2000, 95(1): 323-324. DOI: 10.1111/j.1572-0241.2000.01726.x
    [23]
    GUPTA N, KUMAR A, SHARMA P, et al. Effects of the adjunctive probiotic VSL#3 on portal haemodynamics in patients with cirrhosis and large varices: A randomized trial[J]. Liver Int, 2013, 33(8): 1148-1157. DOI: 10.1111/liv.12172
    [24]
    RINCÓN D, VAQUERO J, HERNANDO A, et al. Oral probiotic VSL#3 attenuates the circulatory disturbances of patients with cirrhosis and ascites[J]. Liver Int, 2014, 34(10): 1504-1512. DOI: 10.1111/liv.12539
    [25]
    North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study[J]. N Engl J Med, 1988, 319(15): 983-989. DOI: 10.1056/NEJM198810133191505
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