{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:26:19Z","timestamp":1790083579727,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,4,21]],"date-time":"2013-04-21T00:00:00Z","timestamp":1366502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Probiotics, by altering gut flora, may favourably alter portal haemodynamics in patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the effect of probiotics on portal pressure in patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomized double\u2010blind placebo\u2010controlled trial conducted in G.B. Pant Hospital, New Delhi. A total of 94 cirrhotic patients having large oesophageal varices without history of variceal bleeding were randomized to three treatment groups and given 2\u00a0months' treatment with propranolol plus placebo, propranolol plus antibiotics (norfloxacin 400\u00a0mg <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>) or propranolol plus probiotic (<jats:styled-content style=\"fixed-case\">VSL<\/jats:styled-content>#3, 900 billion\/day) randomly assigned in 1:1:1 ratio. Outcome measures were change in Hepatic venous pressure gradient (<jats:styled-content style=\"fixed-case\">HVPG<\/jats:styled-content>): Response rate (Percentage of patients having a decrease from baseline of \u226520% or to \u226412\u00a0mm\u00a0Hg) and changes from baseline; biochemical markers of inflammation: changes from baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Adjunctive probiotics increased the response rate compared with propranolol alone (58% vs. 31%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.046), similar to adjunctive antibiotics (54%). The mean fall in <jats:styled-content style=\"fixed-case\">HVPG<\/jats:styled-content> was greater with either adjunctive probiotics (3.7\u00a0mm\u00a0Hg vs. 2.1\u00a0mm\u00a0Hg, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.061) or adjunctive antibiotics (3.4\u00a0mm\u00a0Hg) than with propranolol alone. Both adjunctive therapies were associated with greater decreases in <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010\u03b1 levels (in both peripheral and hepatic venous blood) that resulted from propranolol\u2010only treatment. No clinically relevant between\u2010group differences were observed in the type or frequency of adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adjunctive probiotic (<jats:styled-content style=\"fixed-case\">VSL<\/jats:styled-content>#3) improved the response rate to propranolol therapy and was safe and well tolerated in patients with cirrhosis. Adjunctive probiotic therapy merits further study for reduction in portal pressure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12172","type":"journal-article","created":{"date-parts":[[2013,3,20]],"date-time":"2013-03-20T15:29:52Z","timestamp":1363793392000},"page":"1148-1157","source":"Crossref","is-referenced-by-count":73,"title":["Effects of the adjunctive probiotic <scp>VSL<\/scp>#3 on portal haemodynamics in patients with cirrhosis and large varices: a randomized trial"],"prefix":"10.1111","volume":"33","author":[{"given":"Nitin","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Gastroenterology G.B. Pant Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences (ILBS) New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences (ILBS) New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology G.B. Pant Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barjesh C.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology G.B. Pant Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiv K.","family":"Sarin","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences (ILBS) New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,4,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(02)00430-0"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2003.tb00298.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-006-9310-2"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1015-9584(09)60068-3"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(99)90189-6"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e3282efa40e"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2009.02020.x"},{"key":"e_1_2_6_9_1","first-page":"442","article-title":"Ammonia tolerance in the diagnosis of esophageal varices: a comparison of the endoscopic, radiologic and biochemical techniques","volume":"70","author":"Conn HO","year":"1967","journal-title":"J Lab Clin Med"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-3-200308050-00008"},{"key":"e_1_2_6_11_1","first-page":"74","article-title":"Hepatic venous pressure gradient measurement: time to learn!","volume":"27","author":"Kumar A","year":"2008","journal-title":"Indian J Gastro\u2010enterol"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50133"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)91740-3"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2006.09.013"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2008.01850.x"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50038"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2010.01.006"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.38.2.340"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510290406"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(99)80225-6"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2002.30082"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.12172","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.12172","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.12172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T22:38:56Z","timestamp":1696199936000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.12172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,4,21]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2013,9]]}},"alternative-id":["10.1111\/liv.12172"],"URL":"https:\/\/doi.org\/10.1111\/liv.12172","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4,21]]}}}