Probióticos en las enfermedades hepáticas / Probiotics in liver diseases

En las enfermedades hepáticas, especialmente en la cirrosis y la esteatohepatitis no alcohólica, las alteraciones en la microbiota intestinal y en los mecanismos de respuesta inflamatoria desempeñan un papel importante en la progresión de la enfermedad y el desarrollo de complicaciones. Los probióticos, debido a su capacidad para modular la flora intestinal, la permeabilidad intestinal y la respuesta inmunológica, pueden ser eficaces en el tratamiento de las enfermedades hepáticas y en la prevención de las complicaciones de la cirrosis. Diversos estudios han demostrado la eficacia de diferentes probióticos en el tratamiento de la encefalopatía hepática mínima y en la prevención de episodios de encefalopatía aguda. Otros campos en los que se han observado efectos beneficiosos de los probióticos son el tratamiento de la esteatohepatitis no alcohólica y la prevención de infecciones bacterianas en los pacientes con trasplante hepático. Sin embargo, son precisos más estudios para confirmar la eficacia y seguridad de los probióticos en los pacientes con enfermedades hepaticas, así como para conocer mejor sus mecanismos de acción (AU)

Alterations in intestinal microbiota and inflammatory response play a key role in disease progression and development of complications in liver diseases, mainly in cirrhosis and non-alcoholic steatohepatitis. Probiotics can be useful to delay disease progression and to prevent development of complications due to their ability to modulate intestinal flora, intestinal permeability and inflammatory response. Several studies have shown the efficacy of probiotics in the treatment of minimal hepatic encephalopathy and the prevention of episodes of overt hepatic encephalopathy. Probiotics have also been observed to prevent postoperative bacterial infections and to improve liver damage in non-alcoholic steatohepatitis. However, more studies are needed in order to confirm the efficacy and safety of probiotics in patients with liver diseases, and to better understanding of the mechanisms implicated in their effects (AU)

Surgical treatment of a descending aortic aneurysm in a patient with noncirrhotic portal hypertension and a portal systemic shunt.

A 63-year-old male with atrial fibrillation and mild mitral valve regurgitation was referred to hospital because of a descending aortic aneurysm. During the evaluation, he developed an encephalopathy because of hyperammoniaemia. Further examination revealed a portal systemic shunt, perhaps caused by the noncirrhotic portal hypertension. The patient underwent successful replacement of the aneurysm after controlling the blood ammonia level by eliminating protein from the diet and removal of nitrogen from the gastrointestinal tract. Cardiovascular surgery in a patient with noncirrhotic portal hypertension and a portal systemic shunt has not been previously reported. Meticulous management of the perioperative blood ammonia concentration is essential.

Effects of low-sodium diet and spironolactone on portal pressure in patients with compensated cirrhosis.

The aim of this study was to investigate the hemodynamic effects of spironolactone associated with a low-sodium diet (n = 14) or a low-sodium diet alone (n = 9) in patients with compensated cirrhosis and portal hypertension. Spironolactone significantly reduced the plasma volume. This effect was associated with a significant reduction in the hepatic venous pressure gradient, from 17.6 +/- 3.6 mm Hg to 15.3 +/- 3.5 mm Hg (-13% +/- 13%; p < 0.01). Azygos blood flow (-20% +/- 20%), cardiac output (-16.2% +/- 10.5%) and mean arterial pressure (-9% +/- 9%) also decreased significantly. However, there were no significant changes in hepatic blood flow. Patients receiving low-sodium diet alone experienced a mild but significant reduction in hepatic venous pressure gradient (-6.3% +/- 6%) and in mean arterial pressure (-4% +/- 5%). There were no significant changes in cardiac output and in hepatic or azygos blood flows. This study indicates that low-sodium diet plus administration of spironolactone reduces portal pressure and azygos blood flow in patients with compensated cirrhosis. Low-sodium diet alone only produces mild effects that are likely to be clinically irrelevant.