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Current evidence suggests that both overt hepatic encephalopathy and minimal hepatic encephalopathy (MHE) are associated with the accumulation of ammonia, which is a gut-derived neurotoxin. Given that lactulose and rifaximin, the two most commonly used agents for the treatment of encephalopathy, are thought to be effective through modulation of gut flora, it should follow that patients with MHE would have more ammonia-increasing bacteria than others.
To find out, investigators in China compared gut microbiome characteristics in 26 patients with cirrhosis and MHE, 26 matched healthy relatives, and 25 patients with cirrhosis but without MHE. Using 16S ribosomal RNA–based pyrosequencing, they analyzed 241,622 bacterial 16S rDNA gene sequences f…