The use of saccharomyces boulardii for the treatment of hepatic encephalopathy an experimental study

Objective : Hepatic encephalopathy is a neuropsychiatric condition thatdevelops with an abnormal consciousness, condition as a result of acute or chronic liverdisease. Hepatic encephalopathy can be seen in stages from psychomotorabnormalitiesto severe coma. The pathogenesis of hepatic encephalopathy is not clear, but ammonia,which has been produced as a result of metabolism of enteric flora, has beenconsideredas the most important factor. The lactulose and the antibiotics which were used for thetreatment of the hepatic encephalopathy are not the ideal treatment methods because ofundesired side effects. Living microorganisms that have a regulatory effect on theenteric flora are considered to be the ideal treatment option via affecting the mechanismof hepatic encephalopathy pathogenesis.Materials and methods : Thirty-five wistar albino type female rat have beendivided into 5 groups, having 7 rat in each. One group has been determined as a controlgroup and experimental HE has been formed in other groups by giving 600 mg/kg TAAinto peritonea at the beginning 0 and 24 th hours. Among the groups which TAA havebeen given, one has been given lactulose only, the other one has been givenSaccharomyces boulardii only, and the other group has been given both lactulose and- 61 -Saccharomyces boulardii treatment. Blood samples have been taken before and afterthe study for the ammonia, AST and ALT levels. After the study, the blood culture,ileal content, splenic tissue culture, mesenteric lymph node (MLN) and liver biopsyhave been taken.Results : Experimental HE has been developed by thioacetamid. Significantdecrease in the levels of ammonia, AST and ALT levels have been determinedstatistically with the treatment of lactulose and Sacharomyces boulardii. Significantdecrease have been determined statistically with treatment by lactulose andSaccharomyces boulardii in the bacterial overgrowth. Even though a 43% decreasewith lactulose treatment, and a 58% decrease with the Saccharomyces boulardiitreatment have been observed in bacterial migration, these did not lead to a statisticallysignificant result. No positive effects of lactulose and Saccharomyces boulardiitreatment have been determined for the progression and mortality of HE. No differencehas been observed for the single or combined treatment of lactulose and Saccharomycesboulardii.Conclusion : Sacharomyces boulardii has a positive effect in decreasing livertransaminases and the ammonia levels, in severe liver failure.Key words : Hepatic encephalopathy, bacterial overgrowth, bacterialtranslocation, probiotic, Sacharomyces boulardii.