Assessment of Lactobacillus casei rhamnosus (LGG) therapy in children with biliary atresia – Randomized placebo controlled trial - 11/11/21
, Ilona Motyl b, Piotr Socha aBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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Abstract |
Background |
The role of microbiota in biliary atresia (BA) remains unclear. The aim of our study was to assess efficacy and safety of LGG treatment in children with BA after HPE with special focus on bacterial cholangitis (BCH) and quantitative assessment of the gut microbiota composition and metabolism.
Methods |
We performed double-blind placebo controlled trial with patients randomized into treatment group who received LGG (n = 14) and placebo (n = 16). The gut microbiota and short-chain fatty acids (SCFA) were assessed at baseline and after 6 months of treatment. Clinical and laboratory parameters including episodes of bacterial cholangitis (BCH) were collected during the study period and after 2-year follow-up. Additionally, stool composition of BA patients was compared with healthy age-matched control group.
Results |
There were lower concentration of SCFA in children with BA compared to control group and significant increase in the number of Enterococcus bacteria. After 6 months of treatment, neither laboratory parameters nor gut microbiota composition differed between LGG group and placebo. PP analysis results were similar to ITT analysis, no significant differences between study and control group. Overall, there were 11 (36%) patients who developed at least one episode of bacterial cholangitis; 3 (21%) in the LGG group compared to 8 (50%) placebo group (p = 0.14). Bacterial cultures were positive in 22% of cases and recurrence after the first episode was observed in 27% of patients. The level of total bilirubin decreased below 2 mg/dl after 6 months of the study in 6 (42.8%) patients in the LGG group and in 8 (50%) patients in the placebo group (p = 0.73). During 2-year follow-up 6 out of 14 patients (42.8%) in the LGG group and 11 out of 16 placebo patients (68.7%) underwent liver transplantation (p = 0.27).
Conclusions |
Patients with BA present with specific microbiota profiles and decreased SCFA what gives opportunities to implement novel therapeutic options based on modulation of microbiota. Whether LGG is an effective therapy needs to be studied in a larger group with similar outcome parameters.
Il testo completo di questo articolo è disponibile in PDF.Highlights |
• | Patients with BA present with different gut microbiota compared to healthy children. |
• | Specific microbiota profiles and decreased SCFA in biliary atresia may result from obscured bile flow. |
• | Microbiota modulation is potential approach to reduce the risk of bacterial cholangitis and to improve outcomes in biliary atresia. |
Keywords : Bacterial cholangitis, Hepatoportoenterostomy, Probiotic, Prebiotic, Liver transplantation
Abbreviations : BA, HPE, BCH, NAFLD, SCFAs, LGG, UDCA, CRP, ALT, AST, GGTP, A1AT, PP, ITT, LTx
Mappa
| Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. |
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| Conflict of Interest: No conflict of interest. |
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| Contributors’ Statement Page |
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| Ewa Orłowska collected data, conceptualized and designed the study, designed the data collection instruments, drafted the initial manuscript, reviewed, revised and final approved the manuscript. |
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| Piotr Czubkowski: designed the data collection instruments, carried out the analyses, drafted the initial manuscript, reviewed and revised the manuscript. |
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| Katarzyna Wołochowskia: collected data, drafted the initial manuscript, reviewed and revised the manuscript. |
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| Ilona Motyl: collected data, drafted the initial manuscript, reviewed and revised the manuscript. |
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| Dorota Jarzębicka: collected data, drafted the initial manuscript, reviewed and revised the manuscript. |
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| Piotr Socha: conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript. |
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| All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. |
Vol 45 - N° 6
Articolo 101753- Novembre 2021 Ritorno al numero
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