HEP4-18-0199 - EFFECT OF A MULTISTRAIN PROBIOTIC ON COGNITIVE FUNCTION AND RISK OF FALLS IN PATIENTS WITH CIRRHOSIS: A RANDOMIZED TRIAL. Human gut metagenome

Probiotics can modulate gut microbiota, intestinal permeability and immune response and therefore could improve cognitive dysfunction and contribute to avoid its consequences, such as falls, in patients with cirrhosis. The aim was to evaluate the effect of a multispecies high-concentration multistrain probiotic on cognitive function, risk of falls and inflammatory response in cirrhotic patients. Consecutive outpatients with cirrhosis and cognitive dysfunction (defined by a Psychometric Hepatic Encephalopathy Score (PHES) <-4) and/or falls in the previous year were randomized to receive one sachet of a multistrain probiotic containing 450 billion bacteria every 12 hours for 12 weeks, or placebo. We evaluated the changes in cognitive function (PHES), risk of falls (Timed Up & Go-Test-TUG, gait speed and incidence of falls), systemic inflammatory response (CRP, TNF-α, IL-6, IL-10 and neutrophil and monocyte oxidative burst), intestinal barrier integrity (serum fatty acid binding protein-FABP-6 and 2 and zonulin and urinary claudin-3), bacterial translocation (lipopolysaccharide binding protein-LBP), and fecal microbiota. Thirty-six patients were included. Patients treated with the probiotic (n=18) showed a significant improvement in the PHES (p=0.006), TUG (p=0.015), gait speed (p=0.02), and a trend towards a lower incidence of falls during follow-up (0% compared to 22.2% in the placebo group [n=18], p=0.10). In the probiotic group, there was a decrease in CRP (p=0.01), TNF-α (p=0.01), FABP-6 (p=0.009) and claudin-3 (p=0.002), and an increase in poststimulation neutrophil oxidative burst (p=0.002) with no significant changes in LBP or fecal microbiota. We did not observe significant changes in any of the parameters studied in the placebo group. Conclusion: This multispecies high-concentration multistrain (Is no repetition here with multispecies and multistrain?) probiotic improved cognitive function, risk of falls, inflammatory response and intestinal barrier in patients with cirrhosis and cognitive dysfunction and/or previous falls.