Clostridium butyricum reduces the incidence of overt hepatic encephalopathy in patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS)

INTRODUCTION AND OBJECTIVES: Hepatic encephalopathy (HE) is a major complication after transjugular intrahepatic portal shunt (TIPS), affecting patients' quality of life. This study evaluated the efficacy of Clostridium butyricum combined with lactulose in preventing HE after TIPS. PATIENTS AND METHODS: Patients were randomly divided into two groups: Clostridium butyricum plus lactulose group (trial group) and lactulose group (control group). Prophylaxis started within 24 hours post-TIPS and lasted 3 months. The primary endpoint was the occurrence of HE at 1 and 3 months after TIPS. The study also analyzed the impact on gut microbiota. RESULTS: No significant difference in minimal hepatic encephalopathy (MHE) incidence between the two groups. However, the trial group had a significantly lower overt hepatic encephalopathy (OHE) incidence than the control group at both one month (8.2% vs. 26.5%, P = 0.016) and three months (10.2% vs. 34.7%, P = 0.004) (HR=3.867, P = 0.008; aHR=4.819, P = 0.004). The trial group showed a higher skeletal muscle index at the third lumbar vertebra at 3 months after TIPS (42.85 ± 10.66 vs. 38.38 ± 8.61 cm²/m², P = 0.024). Combining treatment can reduce the occurrence of OHE in patients with sarcopenia (48.3% vs. 15%, P = 0.016). The abundance of butyrate-producing bacteria and the level of butyric acid in the trial group at 3 months after TIPS was significantly increased compared to the baseline. The levels of TNF-α and D-LDH in the trial group were significantly lower than those in the control group at 3 months after TIPS. CONCLUSIONS: Clostridium butyricum plus lactulose can significantly reduce the incidence of OHE after TIPS and improve nutritional status. In addition, combined therapy can also increase the abundance of beneficial bacteria in stool, increase the level of butyric acid in stool, and improve the inflammatory state in patients undergoing TIPS.