Oligofructose improves cerebral function in patients with minimal hepatic encephalopathy
Minimal hepatic encephalopathy (MHE) describes patients with chronic liver disease or cirrhosis who have no clinical symptoms of brain dysfunction but who perform worse on psychometric test compared with healthy subjects. It manifests as memory reduction, personality changes, and impairment of concentration and reaction times. Its prevalence varies between 30-84% in patients with liver cirrhosis. MHE is linked to enhanced production of toxins by the gut, e.g. ammonia, which affects cerebral functioning.
The aim of the study was to investigate whether dietary strategies to reduce the production and absorption of neurotoxic substances from the gastrointestinal tract can improve the condition. Sixty-six cirrhotic patients (33-57 years of age) were randomised in two groups receiving either Bifidobacterium longum and oligofructose (2.5 g/day) or placebo in a double-blind manner. After 90 days of intervention, fasting NH4 serum levels were significantly decreased with the synbiotic (P=0.003 vs. placebo). Performance on the train making test (memory function) was significantly enhanced (P<0.001 vs. placebo), symbol digit modalities test (attention, motor function and processing speed) was significantly improved (P<0.05), block design (spatial reasoning and processing speed) (P<0.001 vs. placebo), as well as performance on mini mental state examination tests (cognitive dysfunction) were significantly improved (P<0.001 vs. placebo) after 90 days.
In conclusion, the results of the study indicate that synbiotic administration dramatically reduced the level of ammonia production in the gut, which lowered blood ammonia levels (54% less compared with baseline). This let to an improvement and recovery of neuropsychological activities related to short-term memory, attention and computing ability, language, orientation ability and cognitive activities.
Malaguarnera M, Greco F, Barone G, Gargante MP, Malaguarnera M, Toscano MA (2007) Bifidobacterium longum with fructo-oligosaccharide (FOS) treatment in minimal hepatic encephalopathy: a randomised, double-blind, placebo-controlled study. Dig. Dis. Sci. 52: 3259-3265.
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