Recent evidences confirm that probiotics can modulate the intestinal microbiota, intestinal permeability and immune response: hence, the suggestive and reasonable hypothesis that an integration with probiotics could also improve the cognitive dysfunction and be helpful in patients affected by cirrhosis. This was the main goal of Dr Germán Soriano and colleagues, who evaluated the effect of the De Simone Formulation on cognitive function and inflammatory response in patients with cirrhosis. For this purpose, thirty-six patients with cirrhosis and cognitive dysfunction were enrolled and randomly divided into two groups to receive one sachet of probiotic twice a day for 12 weeks, or a placebo. Changes in cognitive function were assessed with the Psychometric Hepatic Encephalopathy Score (PHES), while the risk of falls was verified with a special test that measured the gait speed and incidence of falls; other parameters evaluated were the systemic inflammatory response, the neutrophils oxidative stress, the permeability of the intestinal barrier (through the detection of FABP-6 and Claudia-3 proteins), the bacterial translocation and the fecal microbiota. Patients treated with probiotic showed an improvement in PHES (p = 0.006), a better time (p = 0.015) and gait speed (p = 0.02) and a tendency to a lower incidence of falls during the follow-up (0% compared to 22.2% in the placebo group, p = 0.10). In the probiotic group, a decrease in the concentration of the C-reactive protein (p = 0.01), and lower levels of the tumor necrosis factor alpha (p = 0.01), FABP-6 (p = 0.009) and claudin-3 (p = 0.002) were also observed, in addition to an increase in the post-stimulation oxidative stress of neutrophils (p = 0.002). In conclusion, the De Simone Formulation improved the cognitive function of the treated patients, lowering the risk of falls and the inflammatory response.
In the probiotic group, a decrease in the concentration of the C-reactive protein (p = 0.01), and lower levels of the tumor necrosis factor alpha (p = 0.01), FABP-6 (p = 0.009) and claudin-3 (p = 0.002) were also observed, in addition to an increase in the post-stimulation oxidative stress of neutrophils (p = 0.002).

In conclusion, the De Simone Formulation improved the cognitive function of the treated patients, lowering the risk of falls and the inflammatory response.

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Hepatology Communications 2019; 3: 632-645
https://europepmc.org/abstract/med/31061952