High-dose Probiotic Supplement May Improve Response Rate to Propranolol in Patients with Cirrhosis and Large Varices
In a randomized, double-blind, placebo-controlled trial involving 94 cirrhotic patients with large esophageal varices without a history of variceal bleeding, supplementing with a high-dose probiotic (VSL#3, providing 900 billion/d) in addition to propranolol was found to increase the response rate to treatment, as compared to treatment with propranolol alone (58% vs 31%), and had a similar effect as propranolol plus adjunctive antibiotics (54%). The mean fall in HVPG was 3.7 mm Hg with adjunctive probiotics and 3.4 mm Hg with adjunctive antibiotics, as compared to propranolol alone (2.1 mm Hg). Both probiotics and antibiotics led to decreases in TNF-alpha levels (in peripheral and hepatic venous blood). The authors conclude, "Adjunctive probiotic (VSL#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."