Effects of probiotics, lactitol and rifaximin on intestinal flora and fecal excretion of organic acids in cirrhotic patients

Aim: The aim of the present study was to assess fecal organic acid excretion and gut flora changes in a group of patients with compensated liver cirrhosis without hepatic encephalopathy by comparing probiotic, therapy with more common therapeutic approaches. Methods: Thirty patients with compensated Child B liver cirrhosis were allocated into one of three matched groups, which were randomly given one of three 3-week oral treatments: (i) lactitol 20 g t.i.d.; (ii) 400 mg rifaximin b.i.d.; or (iii) the synbiotic SCM-III (Microflorana-F, Named, Lesmo, Italy) 10 mL t.i.d. Stool samples were collected at both the time of entry into the study and at the end of the trial period for the assessment of intestinal bacterial flora and for the determination of fecal pH and of organic acid concentration. Results: All three tested compounds significantly increased the total anaerobic bacterial count to the same extent. The change was mainly due to a reduction in the Bacteriodes population and an expansion of the bifidobacteria population. However, only SCM-III significantly decreased the total count of Bacteroides and Clostridium. Lactitol and SCM-III decreased (to a similar extent) the fecal pH compared with healthy controls and with pretreatment values (P < 0.05). Both lactitol and SCM-III produced a significant increase in the fecal concentration of acetic acid and lactic acid. However, only SCM-III decreased the fecal concentration of toxic short-chain fatty acids. Conclusions: In the present clinical study, we confirmed the findings from an in vitro study of enhanced-non-toxic organic acid recovery from stools during treatment with nonabsorbable disaccharides. In the present study, we found that lactitol did not produce any significant effect on Bacteroides and Clostridium, whereas the specific bacterial counts of such species significantly decreased only in the group treated with the synbiotic. These data suggest a potential role of synbiotics in the long term treatment of chronic liver disease.