{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:04:44Z","timestamp":1791234284521,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":4140,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2004,5]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Minimal hepatic encephalopathy (MHE) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis. Treatment with lactulose is of benefit. The possible role of synbiotics (probiotics and fermentable fiber) has not been assessed. We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials. MHE, defined by abnormality on at least one test modality, was present in 58 (60%) patients. Fifty-five of these patients with MHE were randomized to receive a synbiotic preparation (n = 20), fermentable fiber alone (n = 20), or placebo (n = 15) for 30 days. Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology, with significant fecal overgrowth of potentially pathogenic\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Staphylococcal<\/jats:italic>\n                      species. Synbiotic treatment significantly increased the fecal content of non-urease-producing\n                      <jats:italic toggle=\"yes\">Lactobacillus<\/jats:italic>\n                      species at the expense of these other bacterial species. Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50% of patients. Synbiotic treatment was also associated with a significant reduction in endotoxemia. The Child-Turcotte-Pugh functional class improved in nearly 50% of cases. Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients. In conclusion, treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis. (Hepatology 2004;39:1441-1449.)\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.20194","type":"journal-article","created":{"date-parts":[[2004,4,26]],"date-time":"2004-04-26T19:02:19Z","timestamp":1083006139000},"page":"1441-1449","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":532,"title":["Synbiotic modulation of gut flora: Effect on minimal hepatic encephalopathy in patients with cirrhosis"],"prefix":"10.1097","volume":"39","author":[{"given":"Qing","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong Ping","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da Kang","family":"Ha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stig","family":"Bengmark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelica","family":"Kurtovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M.","family":"Riordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-32-20241201","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1053\/jhep.2002.31552","article-title":"Minimal hepatic encephalopathy: a permanent source of discussion.","volume":"35","author":"Weissenborn","year":"2002","journal-title":"HEPATOLOGY"},{"key":"R2-32-20241201","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1023\/A:1011610427843","article-title":"Quality of life in cirrhotics with minimal hepatic encephalopathy.","volume":"16","author":"Schomerus","year":"2001","journal-title":"Metab Brain Dis"},{"key":"R3-32-20241201","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1111\/j.1440-1746.1998.tb00728.x","article-title":"Cerebral changes in hepatic encephalopathy.","volume":"13","author":"Watanabe","year":"1998","journal-title":"J Gastroenterol Hepatol"},{"key":"R4-32-20241201","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S0168-8278(01)00026-5","article-title":"Neuropsychological characterization of hepatic encephalopathy.","volume":"34","author":"Weissenborn","year":"2001","journal-title":"J Hepatol"},{"key":"R5-32-20241201","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1023\/A:1011654210096","article-title":"Attention deficits in minimal hepatic encephalopathy.","volume":"16","author":"Weissenborn","year":"2001","journal-title":"Metab Brain Dis"},{"key":"R6-32-20241201","first-page":"324","article-title":"Correlations between neuropsychological test performance and brain glucose metabolism in non-alcoholic cirrhotics. 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