{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:51:53Z","timestamp":1787014313723,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,10,31]],"date-time":"2014-10-31T00:00:00Z","timestamp":1414713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Indian Council of Medical Research (ICMR), New Delhi, India","award":["I-607"],"award-info":[{"award-number":["I-607"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2015,8]]},"abstract":"\n Aim<\/jats:title>\n \n Minimal hepatic encephalopathy (\n MHE<\/jats:styled-content>\n ) impairs daily functioning and health\u2010related quality of life in chronic liver disease (\n CLD<\/jats:styled-content>\n ). Lactulose is the standard treatment but has side\u2010effects. Probiotics have an encouraging role in\n MHE<\/jats:styled-content>\n . The aim of the present study was to test whether probiotics are non\u2010inferior to lactulose in improving\n MHE<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients with\n CLD<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u2009227) were screened for\n MHE<\/jats:styled-content>\n using neuropsychometric tests (number connection tests\n A<\/jats:styled-content>\n and\n B<\/jats:styled-content>\n [or figure connection tests\n A<\/jats:styled-content>\n and\n B<\/jats:styled-content>\n ]) and\/or neurophysiological test (\n P<\/jats:styled-content>\n \u2010300 auditory event\u2010related potential), and 120 (53%) were diagnosed with\n MHE<\/jats:styled-content>\n by abnormal tests.\n MHE<\/jats:styled-content>\n patients were randomized to lactulose (30\u201360\u2009mL\/day) or probiotic (four capsules of\n VSL<\/jats:styled-content>\n #3; total of 450\u2009billion\n CFU<\/jats:styled-content>\n \/day) for 2 months. Response was defined as normalization of tests. Serum ammonia was measured by commercial kit.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 120 patients randomized, 40 in the lactulose arm and 33 in the probiotic arm completed 2 months of intervention.\n MHE<\/jats:styled-content>\n improved in 25 (62.5%) patients taking lactulose and 23 (69.7%) taking probiotics. The effect size of difference of improvement in\n MHE<\/jats:styled-content>\n between lactulose and probiotic was 0.072 per per\u2010protocol analysis and 0.040 as per intention to treat analysis (within \u221220% of non\u2010inferiority margin). Serum ammonia was comparable between groups at baseline and 2 months; it decreased in patients in whom\n MHE<\/jats:styled-content>\n improved, while increased in patients with no improvement in\n MHE<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n The probiotic\n VSL<\/jats:styled-content>\n #3 was non\u2010inferior to the standard therapy, lactulose in the treatment of\n MHE<\/jats:styled-content>\n . Improvement in\n MHE<\/jats:styled-content>\n correlated with reduction of ammonia levels.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/hepr.12429","type":"journal-article","created":{"date-parts":[[2014,9,29]],"date-time":"2014-09-29T23:35:55Z","timestamp":1412033755000},"page":"880-889","source":"Crossref","is-referenced-by-count":51,"title":["Effect of probiotic\n VSL<\/scp>\n #3 in the treatment of minimal hepatic encephalopathy: A non\u2010inferiority randomized controlled trial"],"prefix":"10.1111","volume":"45","author":[{"given":"Venigalla","family":"Pratap Mouli","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaya","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences New Delhi 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