Komplexná liečba chronickej hepatálnejencefalopatie doplnená probiotikomPorovnanie dvoch štúdií

Complex Therapy of Chronic Hepatic Encephalopathy Completed withProbiotic: Comparison of Two Studies

Background.
. Several reports about usefulness of probiotics, including Enterococcus faecium in the treatment ofchronic hepatic encephalopathy in patients with liver cirrhosis have been recently published. The results obtainedby the administration of Enterococcus faecium M-74 + seleniumwill be evaluated and compared with those publishedby Loguercio et al. for Enterococcus faecium SF 68.Methods and Results. Fifteen patients with liver cirrhosis, portal hypertension and chronic hepatic encephalopathywere treated, beside the standard therapy, alsowith one capsule of probiotic „Enterococcus faeciumM-74 + Selenium“per day in three four-week periods, separated by two fortnight pauses. During the treatment, every patient wasexamined 9-times. The severity of chronic hepatic encephalopathy was evaluated with the aid of the portal systemicencephalopathy index, calculated from5 parameters (mental stage, asterixis, number connecting test, blood ammonia,EEG). The indexes of initial and final values were compared. The time course of blood ammonia levels and that ofresults from number connecting test in either study were mutually compared on the basis of interval estimates ofquadratic regression function. Significant improvement of the portal systemic encephalopathy index after thetreatment was found: it decreased in average by 70 % (55 to 85 %, interval 95% confidence interval). The mentalstage improved and the asterixis disappeared. The blood ammonia levels as well as the results from the number-connectingtest after 8–9 weeks significantly approached the normal pattern. EEG findings improved and they wereoften normalised. Our starting blood ammonia levels (increased by 31%above norm) and results fromthe connectingtest (increased by 60 %) were significantly lower accordingly the Loguercio et al. (increased by 243 and 238 %,respectively). During the treatment, the values in our study decreased by 25 % and 30 %, in the compared study by50 % and 70 %.Conclusions. Our results proved the hypothetical favourable effect of probioticum Enterococcus faecium M-74 +Selenium on chronic hepatic encephalopathy. Interestingly, a markedly higher relative therapeutic effect has beenachieved in more serious disorder in comparison with the less severe disorders in the present study.

Key words:
hepatic cirrhosis, Enterococcus faecium M-74 + Selenium, chronic hepatic encephalopathy, portalsystemic encephalopathy index, number connecting test, blood ammonia.