{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:04:38Z","timestamp":1784005478680,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":193,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Canadian Journal of Gastroenterology and Hepatology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatic encephalopathy (HE) remains a major cause of hospitalization and readmission in cirrhosis and is closely linked to hyperammonemia, microbial dysbiosis, impaired short\u2010chain fatty acid (SCFA) output, barrier dysfunction, and altered mucosal immunity. We evaluated whether adding a multistrain probiotic to rifaximin was associated with greater neurometabolic improvement and coordinated gut\u2013liver\u2013brain axis changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective, 6\u2010month, randomized, open\u2010label, assessor\u2010blinded, three\u2010arm controlled study, 61 adults with cirrhosis\u2010related HE received standard care alone (Con,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920), standard care plus rifaximin 550\u2009mg twice daily (Rif,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920), or rifaximin plus a multistrain probiotic (1 \u00d7 10^9\u2009CFU three times daily; Rif\u2009+\u2009Pro,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921). The main prespecified biochemical readout was serum ammonia at Month 6. A composite HE index incorporating mental status, flapping tremor, number connection test, and ammonia grade was analyzed as a prespecified exploratory neurometabolic score. A predefined mechanistic subset underwent 16S rRNA microbiome profiling, serum SCFA measurement, and fecal secretory IgA (SIgA) testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics did not differ across arms. Post\u2010treatment serum ammonia decreased in a graded pattern (Con 177\u2009\u00b1\u200943.2, Rif 143\u2009\u00b1\u200937.5, Rif\u2009+\u2009Pro 117\u2009\u00b1\u200934.3\u2009\u03bcmol\/L), with parallel improvement in the exploratory HE index (10.0\u2009\u00b1\u20094.9, 5.3\u2009\u00b1\u20094.7, and 3.7\u2009\u00b1\u20094.1, respectively). In the mechanistic subset, the microbial community structure differed by treatment (PERMANOVA\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Rif\u2009+\u2009Pro was associated with higher serum propionate, increased Lactobacillus salivarius\u2013associated signal, reduced Bacteroides ovatus\u2013associated signal, and marked fecal SIgA elevation compared with standard care or rifaximin alone. The SIgA\u2013propionate relationship was interpreted as exploratory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rifaximin plus multistrain probiotics was associated with greater improvement in serum ammonia and exploratory HE severity readouts than rifaximin alone, accompanied by coordinated microbial, metabolic, and mucosal immune changes. These findings support confirmation in adequately powered event\u2010driven trials with strain\u2010resolved profiling and targeted metabolomics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cjgh\/2389961","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:18:07Z","timestamp":1784002687000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rifaximin Plus Probiotics Reshape Gut Microbiota, Serum Propionate, and Mucosal Immunity in Cirrhosis\u2010Related Hepatic Encephalopathy Microbiota\u2010Immune Remodeling in HE"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5974-1423","authenticated-orcid":false,"given":"Yiping","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shujun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danni","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengdan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luna","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3059-2841","authenticated-orcid":false,"given":"Dylan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2021.100333"},{"key":"e_1_2_14_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.013"},{"key":"e_1_2_14_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.08.004"},{"key":"e_1_2_14_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-019-05576-9"},{"key":"e_1_2_14_5_2","doi-asserted-by":"publisher","DOI":"10.2147\/ijgm.s218405"},{"key":"e_1_2_14_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2020.01.002"},{"key":"e_1_2_14_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmed.2014.05.002"},{"key":"e_1_2_14_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-018-1605-5"},{"key":"e_1_2_14_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-019-0157-3"},{"key":"e_1_2_14_10_2","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s186071"},{"key":"e_1_2_14_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2019.05.004"},{"key":"e_1_2_14_12_2","doi-asserted-by":"publisher","DOI":"10.1194\/jlr.r067629"},{"key":"e_1_2_14_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkx1089"},{"key":"e_1_2_14_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00025"},{"key":"e_1_2_14_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-800100-4.00003-9"},{"key":"e_1_2_14_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-23404-4"},{"key":"e_1_2_14_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/311071a0"},{"key":"e_1_2_14_18_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2013.00185"},{"key":"e_1_2_14_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0105-2896.2005.00278.x"},{"key":"e_1_2_14_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.1.2"},{"key":"e_1_2_14_21_2","doi-asserted-by":"publisher","DOI":"10.3920\/bm2019.0025"},{"key":"e_1_2_14_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0016-5085(77)80135-2"},{"key":"e_1_2_14_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/nmeth.3869"},{"key":"e_1_2_14_24_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.961117"},{"key":"e_1_2_14_25_2","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2005.46.3.399"},{"key":"e_1_2_14_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800600817"},{"key":"e_1_2_14_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12047"}],"container-title":["Canadian 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