Investigation gastrointestinal microbiota alteration on patients using rifaximin and lactulose as treatment of hepatic encephalopathy

Objective: Liver cirrhosis is a common chronic disease which has various aetiologies and hepatic encephalopathy is one of the most significant complications of this disease. Alteration of gut microbiota has become an issue in terms of pathogenesis of hepatic encephalopathy; moreover it is controversial as to what kind of alterations are being caused by the drugs used for its treatment. The aim of this study is to investigate gastrointestinal microbiota alteration on patients using rifaximin and lactulos as treatment and prohylaxis of hepatic encephalopathy and to compare it with other cirrhosis patients. Material and method: This study includes hepatic encephalopathy patients who have visited gastroenterology inpatient and outpatient clinics. 5 hepatic encephalopathy patient's (HE-1 group) gaita examples were collected at the time of diagnosis, 4 compensated cirrhosis (CS group) and 4 decompensated cirrhosis (DC group) patient's gaita examples were collected on admission. 3 months of lactulos and rifaximin treatment was given to the hepatic encephalopathy patient group and 3 of the 5 patients control samples (HE-II) were able to be collected again at the end of the 3 months. The bacterial population's specifications and densities of the collected gaita samples were evaluated using 16S rDNA genetic analysis. Bacteria densities and ratio of bacteria classes and their relationship with HE patient's was compared. Results: Among cirrhosis patients' included in this study, microbiota investigations revealed an increase in enterobacteriaceae that was statistically significant in decompensated cirrhosis patients compared with compensated cirrhosis and all other groups. In the hepatic encephalopathy patient group, no statistically significant differance was detected between pre-treatment collected gaita samples (HE I) and the post-treatment collected gaita samples (HE II). The cirrhosis disbiosis ratio was not found to be significant among any of the groups. Conclusion: Significant alteration of the microbiome was observed in decompensated cirrhosis patients compared with compensated cirrhosis patients. Microbial populations used in the cirrhosis disbiosis ratio (CDR) calculation can vary. Keywords: Cirrhosis, hepatic encephalopathy, intestinal microbiota