This study is a randomized, open, parallel group, active comparator, single center trial. Objectives of the study are hereby given below: * To study the health related quality of life (HRQOL) in patients with chronic liver disease. * To assess the prevalence of minimal hepatic encephalopathy (MHE) in patients with chronic liver disease and assessment of HRQOL in patients with MHE. * To compare the effect of probiotics and lactulose in the treatment of MHE * To assess the effect of probiotics and lactulose on the HRQOL in patients with MHE.
The study design would comprise of two parts 1. Part I: Cross sectional study: This part would comprise of the assessment of HRQOL in patients with CLD 1. All the consecutive patients diagnosed as CLD would be enrolled in the study. All these patients would be enrolled from the liver clinics of the department of gastroenterology and those admitted in the gastroenterology ward at AIIMS. 2. Alcohol would be considered to be the cause of CLD, if the patient regularly consumed ≥80g/d of alcohol for five years 3. The staging of cirrhosis would be done according to the Child Pugh classification: A, B and C 4. The causes of CLD would be divided into:- viral hepatitis, alcohol, viral hepatitis combining with alcohol and miscellaneous causes 2. Part II: Prospective randomized controlled trial: In this part the outcome of lactulose and probiotic therapy in the treatment of MHE and its effect on the HRQOL will be compared. 1. All the consecutive patients with CLD without overt encephalopathy would be screened for MHE. 2. All these patients would be enrolled from the liver clinics and the gastroenterology ward, AIIMS. 3. The diagnosis of MHE would be based on abnormal psychometric tests (NCT-A and NCT-B or FCT-A and FCT-B) and /or abnormal P300 auditory event related potentials.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
120
VSL#3 (2 capsules bid.for 2 months, Each containing 112.5 billion viable lyophilized bacteria). Each capsule contains 4 strains of Lactobacillus (L. casei, L. plantarum, L. acidophilus, and L. delbrueckii subsp. bulgaricus), 3 strains of Bifidobacterium (B. longum, L. breve, and B. infantis), and 1 strain of Streptococcus salivarius subsp. thermophilus (designated hereafter as S. thermophilus)
30-60 ml of lactulose per day for 2 months to ensure 2-3 soft stools.
Dept. of Gastroenterology and H.N.U., All India Institute of Medical Sciences
New Delhi, National Capital Territory of Delhi, India
To compare the effect of probiotics and lactulose based on normalization of the abnormal test parameters, Neuropsychometric tests, P3ERP, EEG, venous ammonia levels, Development of overt encephalopathy and other complications and HRQOL
Time frame: 2 months
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