Role of probiotics in primary prevention of esophagogastric variceal bleeding / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the effect of probiotics on the risk of esophagogastric variceal bleeding (EVB) within 1 year in cirrhotic patients with gastroesophageal varices. MethodsA 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. ResultsProbiotic 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］. ConclusionProbiotics 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.