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META NUñEZA SERVANDO SORIASO
META NUñEZA SERVANDO SORIASO
GROUP PROPOSAL
Presenters:
Nuñeza, Klaudine
Servando, Allisone Eunice
Soriaso, James Nicole
la
TITLE:
The Efficacy of Probiotics as Secondary Prophylaxis in
Minimal Hepatic Encephalopathy in Comparison to
Lactulose:
A Meta-Analysis Approach
CHAPTER 1
Introduction
• Hepatic Encephalopathy is one of the complications of
long term, decompensated liver cirrhosis and broadly
defined as having altered mental condition and abnormal
cognitive functions in the presence of liver failure.
• It is usually qualified using the West Haven Grading
System and is classified as covert versus overt Hepatic
Encephalopathy.
• It is then further graded from Grade 1 to 4 as Minimal,
Mild, Moderate, and Severe respectively.
• Probiotics, is defined by Food and Agriculture
Organization of the United Nations (FAO) and the WHO
as “live microorganisms which when administered in
adequate amounts confer a health benefit on the host”
• Probiotics can stimulate gut microbiota modulation which
plays an important role in enhancing intestinal mucosal
barrier function.
• This contributes to a decrease in the levels of ammonia in
the blood consequently preventing hepatic
encephalopathy to occur.
• Lactulose has laxative characteristics causing a decrease
in the synthesis and uptake of ammonia by decreasing
colon pH and also reducing glutamine uptake.
• Lactulose is converted into monosaccharide by normal
flora and used as a food source so that the growth of
normal intestinal flora will suppress other bacteria that
produce urease.
CHAPTER II
Rationale of the Study
ELIGIBILITY CRITERIA
INCLUSION CRITERIA
EXCLUSION CRITERIA
INCLUSION CRITERIA
• POPULATION ATTRIBUTES
– Out patients with minimal hepatic encephaloptahy regardless of
the etiology
– Patients age 18 to 75 years old
– Male and female sexes
– All races
– Patients with stable comorbidities
EXCLUSION CRITERIA
• Patients with overt hepatic encephalopathy
• Patients with history of taking lactulose or any antibiotics, and alcohol intake in
the past 6 weeks
• Patients receiving secondary prophylaxis for spontaneous bacterial peritonitis
• Patients with previous transjugular intrahepatic portosystemic shunt or shunt
surgery
• Patients with significant comorbid illness such as heart, respiratory or renal
failure and any neurological disease
• Patients with hepatocellular cacinoma
• Patients receiving psychoactive drugs
• Non-RCT studies
• Date of Interest: 2008-2022
• Exposure of Interest: Patients with minimal hepatic
encephalopathy
• Age of Interest: 18 years old to 75 years old
• Gender of Interest: Male and Female
• Language: English
• Participants: Cochrane Library, PubMed, Elsevier,
Clinical Trials.gov.MedRvix, Herdin Plus
• Setting of Interest: Out Patients
• Study Design: Randomized Clinical Trials
• Prefilled Eligibility Criteria
• Types of Participants:
• Patients with Minimal hepatic encephalopathy
• Adult patients (Ages 18 to 75 years old)
• Male or Female
• All races
• Outpatient setting
III.
• Types of Intervention
– Probiotics 3 capsules a day
– Lactulose 30-60ml/day
Databases Selected:
– Cochrane Library
– PubMed/ncbi
– Clinical Trials.gov.
– Herdin Plus
• Designing Search Strategies
– PICO FORMAT
• P: Patients with minimal hepatic encephalopathy regardless of etiology
• I: Probiotics
• C: versus Lactuose
• O: Reducing the occurence of overt hepatoencephalopathy
• Search Strategy:
– Terms to search for health condition (Minimal hepatic encephalopathy,
Portosystemic encephalopathy, Liver cirrhosis)
– Terms to search for the type of study design to be included (Randomized Control
Trial)
– Terms to search for intervention (Probiotics, Gut microbiota modulators)
• Timing of Searches:
– Within 15 years ( 2008-2022)
Search Filters:
Documenting and Reporting the search Process:
• Guidance from medical or healthcare librarian
• Bibliographic database are copied and pasted in an appendix
76 non duplicate
Criteria Applied
17 Articles Retrieved
Eligibility
4 Articles Included
Research Timeline
Activity Weeks 1 2 3 4 5 6 7 8 9
Phase
Reading and
Research
Topic Presentation
Topic Interpretation
Analysis Results
Reference
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Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and
Nonalcoholic Cirrhosis Patients. Gut Liver. 2016 Jan;10(1):95-100. doi: 10.5009/gnl14363.
PMID: 26087788; PMCID: PMC4694740.
• Wong SN, Ong JP, Labio ME, Cabahug OT, Daez ML, Valdellon EV, Sollano JD Jr, Arguillas
MO. Hepatitis B infection among adults in the philippines: A national seroprevalence study.
World J Hepatol. 2013 Apr 27;5(4):214-9. doi: 10.4254/wjh.v5.i4.214. PMID: 23671726;
PMCID: PMC3648653.
• Dalal R, McGee RG, Riordan SM, Webster AC. Probiotics for people with hepatic
encephalopathy. Cochrane Database Syst Rev. 2017 Feb 23;2(2):CD008716. doi:
10.1002/14651858.CD008716.pub3. PMID: 28230908; PMCID: PMC6464663.