Chemistry Reference
In-Depth Information
treated group (110 ± 86,
p
< 0.05), while it remained unchanged in the placebo group.
The improvements in liver function were accompanied by significant improvements
in psychometric tests and in the degree of encephalopathy.
In a follow-up study by the same group of investigators 30 patients with liver
cirrhosis were randomized to receive either Synbiotic 2000 or placebo (crystalline
cellulose) for 7 days.
94
Viable fecal counts of
Lactobacillus
species, Child-Pugh class,
plasma retention rate of indocyanine green (ICG
R15
), whole blood TNF-α mRNA,
IL-6 mRNA, serum TNF-α, soluble TNF receptor (sTNFR)I, sTNFRII and IL-6, and
plasma endotoxin levels were measured pre- and posttreatment: Synbiotic treatment
was associated with significantly increased fecal lactobacilli counts and significant
improvements in plasma retention rate of ICG
R15
and stage of liver disease (Child-Pugh
classification). No significant changes in any study parameter followed placebo treat-
ment, but significant increases in whole blood TNF-α mRNA and IL-6 mRNA, along
with serum levels of soluble TNF receptors sTNFRI and sTNFRII, were observed in
the Synbiotic 2000-treated patients. TNF-α and IL-6 levels correlated significantly,
both at baseline and after synbiotic treatment. Synbiotic-related improvement in
ICG
R15
was significantly associated with changes in IL-6, both at mRNA and protein
levels, and unrelated to plasma endotoxin values. It was concluded that even short-
term synbiotic treatment can significantly modulate gut flora and improve liver func-
tion in patients with cirrhosis. The observed benefits seemed unrelated to reduction
in endotoxemia, but could be mediated, at least in part, by treatment-related induction
of IL-6 synthesis by TNF-α. These results offer great hope that synbiotic treatment
of patients on the waiting list for liver transplantation might prevent septic episodes,
improve liver function, and promote successful outcome of surgery.
In another study, 66 patients were randomized to either receive Synbiotic 2000
or only the fibers in Synbiotic 2000 in connection with human orthotopic liver trans-
plantation. The treatment started on the day before surgery and continued for 14 days
after surgery. During the first postoperative month only 1 patient in the Synbiotic
2000-treated group (3 percent) showed signs of infection (urinary infection) com-
pared to 17 of 33 (51 percent) in the patients supplemented with only the four fibers.95
95
The infecting organisms in the synbiotic-treated group were
Enterococcus faecalis
in 1 patient and in the only fiber-treated group
E. faecalis/faecium
in 11 patients,
E. coli
in 3 patients,
Enterobacter cloacae
in 2 patients,
Pseudomonas aeruginosa
in two patients, and
Staphylococcus aureus
in 1 patient. The use of antibiotics was
on average 0.1 ± 0.1 days in the synbiotic-treated patients and 3.8 ± 0.9 days in the
fiber-only group.
8.10.5 synbiotics in Inflammatory bowel Disease
Daily rectal instillations with Synbiotic 2000 reconstituted in saline were given
to 10 patients with distal colitis for 2 weeks. One patient withdrew after 1 week; the
remaining patients showed dramatic improvements in various disease scores during
the 3 weeks of observation: episodes of diarrhea (decreased from 2.4 to 0.8), visible
blood in stool (2.2 to 0.8), nightly diarrhea (0.5 to 0), urgency (1.9 to 1.0), and con-
sistency of stool (1.1 to 0.8).
96
In the study, 2 patients reported significant bloating
