Essential phospholipids as a supportive adjunct in the management of patients with NAFLD

Background and study aims: Treatment of nonalcoholic fatty liver [NAFLD] is important because NAFLD patients have a 1.7-fold increase in standardised age and gender matched mortality. Currently treatment is based on life style modification and managing comorbid associating disease. Other medications remain experimental. Essential phospholipid [EPL] is a nutrient for the liver, helping to maintain vitality of cell membranes where the vast majority of liver activities are regulated. We performed a randomised open label study to evaluate EPL as an adjuvant nutrient to the treatment of primary NAFLD or NAFLD with comorbid disease

Patients and method: Three groups of NAFLD patients were recruited: lone [n = 113], diabetes mellitus type 2 [n = 107] and mixed hyperlipidaemia [n = 104]. Diagnosis was established by excluding other chronic liver diseases. A standard diet and physical activity plan were advised to all patients. 1800 mg of EPL a day was given for 24 weeks, followed by 900 mg for 48 weeks

Results: Essential phospholipid EPL led to a significant improvement of symptoms and a mean reduction of ALT of 50.8 IU and AST of 46.1 IU per patient [p < 0.01]. Abdominal ultrasonography indicated normalisation in 4.6% and a shift from grade II to grade I in 24% of patients. Liver stiffness measurement indicated an improvement in 21.1%, with a mean reduction in the LSM of 3.1 K Pascal/patient. Reducing the dosage after six months led to a limited relapse in 43.8-63.2% of patients, for lone and NAFLD with co-morbid conditions

Conclusion: Essential phospholipid [EPL] as a nutritional supplement resulted in a significant improvement in clinical parameters and transaminases for all NAFLD patients. Ultrasound and LSM revealed modest improvement. There is a need for uninterrupted maintenance to avoid relapse

Do probiotics improve eradication response to Helicobacter pylori on standard triple or sequential therapy?

The standard triple therapy for the eradication of Helicobacter pylori consists of a combination of a proton pump inhibitor at a standard dose together with two antibiotics [amoxicillin 1000 mg plus either clarithromycin 500 mg or metronidazole 400 mg] all given twice daily for a period of 7-14 days. Recent reports have shown a dramatic decline in the rate of H. pylori eradication utilizing standard triple therapy from 95% down to 70-80%. Our study was designed to evaluate the effect of adding a probiotic as an adjuvant to common regimens used for H. pylori eradication. An open label randomized observational clinical study was designed to test three different regimens of H. pylori eradication treatment: Standard triple therapy with a concomitant probiotic added at the same time [n = 100], starting the probiotic for 2 weeks before initiating standard triple therapy along with the probiotic [n = 95], and the third regimen consists of the probiotic given concomitantly to sequential treatment [n = 76]. The three arms were compared to a control group of patients treated with the traditional standard triple therapy [n = 106]. The eradication rate for the traditional standard therapy was 68.9%, and adding the probiotic "Bifidus infantis" to triple therapy, led to a successful rate of eradication of 83% [P < 0.001]. Pre-treatment with 2 weeks of B. infantis before adding it to standard triple therapy increased the success rate of eradication to 90.5%. Similar improvement in eradication rate was noted when B. infantis was added as an adjuvant to the sequential therapy leading to an eradication rate of 90.8%. Adding B. infantis as an adjuvant to several therapeutic regimens commonly used for the eradication of H. pylori infection significantly improves the cure rates