The impact of probiotics on gut microbiota and non-alcoholic fatty liver disease (NAFLD) progression based on controlled attenuated parameter (CAP) elastography: Randomized controlled trial

Background: The gut–liver axis has many implications in non-alcoholic fatty liver disease onset as the major contributor of intestinal dysbiosis. Gut microbiota have an important role in intestinal barrier function and reversal of leaky gut. Probiotics may restore intestinal barrier integrity and contribute to hepatic functions recovery and alleviating inflammatory and fibrogenic processes. We aimed to evaluate the impact of probiotics on gut microbiota and non-alcoholic fatty liver disease progression. Results: Sixty non-alcoholic fatty liver disease patients (30 non-alcoholic fatty liver and 30 non-alcoholic steatohepatitis patients) were included in this open label randomized controlled study. Half of the patients of each group were randomized to receive probiotics in addition to classic management. The patients were followed-up for 6 months. The non-alcoholic fatty liver disease patients in the probiotic group experienced significant improvement in their Alanine aminotransferase, triglycerides, liver steatosis, and fibrosis stages, fecal pathological bacterial growth and Lactobacillus acidophilus abundance (P= 0.05, 0.029, 0.012, 0.013, 0.034, <0.001 and 0.005 respectively). Waist circumference and low density lipoprotein improvements were more pronounced in non-alcoholic fatty liver patients. Conclusion: Adding probiotic therapy to classical management of non-alcoholic fatty liver disease may help in improving intestinal dysbiosis, liver steatosis and fibrosis

Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax

Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80%) patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20%) patients, blockage of the catheter in only 2 (3.3%) patients, and rapid reaccumulation of fluid in 12 (20%) patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169

Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy

Background. Portal hypertensive gastropathy (PHG) is a common anomaly with potential for bleeding found in portal hypertension. Blood ammonia levels correlate well with liver disease severity and existence of portosystemic shunts. Increased ammonia results in vasodilation and hepatic stellate cell activation causing and exacerbating portal hypertension. Objective. To assess the relation of blood ammonia to the presence and severity of portal hypertensive gastropathy in cirrhosis. Methods. This cross-sectional study included 381 cirrhotics undergoing screening for esophageal varices (EV) divided into a portal hypertensive gastropathy group (203 patients with EV and PHG), esophageal varix group (41 patients with EV but no PHG), and control group (137 patients with no EV or PHG). A full clinical examination, routine laboratory tests, abdominal ultrasonography, child score calculation, and blood ammonia measurement were performed for all patients. Results. Blood ammonia, portal vein, splenic vein, and splenic longitudinal diameters were significantly higher and platelet counts lower in patients with EV and EV with PHG than controls. Patients having EV with PHG had significantly higher bilirubin and ammonia than those with EV but no PHG. Severe PHG was associated with significantly higher ammonia, EV grades, and superior location and a lower splenic longitudinal diameter than mild PHG. The PHG score showed a positive correlation with blood ammonia and a negative correlation with splenic longitudinal diameter. Conclusions. Blood ammonia levels correlate with the presence, severity, and score of portal hypertensive gastropathy in cirrhosis suggesting a causal relationship and encouraging trials of ammonia-lowering treatments for the management of severe PHG with a tendency to bleed