Complex therapy of non-alcoholic fatty liver disease in combination with the syndrome of intestinal bacterial overgrowth
Year: 2019
Type: article
Study design: Clinical Trial
Abstract: Objective — to study the effects of three-month administration of the combined cytoprotector L-Betargin on the lipid and carbohydrate metabolism, biochemical markers of liver damage, the degree of its steatosis and fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) against the background of metabolic syndrome (MS), depending on the presence of syndrome of intestinal bacterial overgrowth (SIBO) and after its correction with probiotic Spazmolac.Materials and methods. Observations involved 60 patients with NASH, developing against the MS background. The diagnosis of steatohepatitis was established based on the multimodal sonographic study of the liver, including conventional echography, Doppler sonography, shear wave elastography, and liver steatometry. The degree of steatosis (S1-S3) was determined by the attenuation coefficient (CG) of the ultrasonic wave SAR, the degree of fibrosis (F1-F4) by the average hardness of the parenchyma. The MS presence was confirmed with generally accepted diagnostic criteria. The SIBO diagnosis was established using the H2-lactulose hydrogen test. All patients were evaluated abdominal symptoms — dyspepsia, pain, bloating, stool frequency. The biochemistry included determination of the transaminases, gamma-glutamine transferase, the levels of bilirubin and fractions, HbA1c, cholesterol, low and high-density lipoproteins, triglycerides.The patients were randomized into two comparable groups. The first group consisted of 30 subjects, who were administered L-Betargin for 3 months in a dose of 1 stick 3 times a day, 30 patients of second group people took silymarin 45 mg 3 times a day. Four weeks after the treatment start, the SIBR, biochemical parameters and multimodal liver sonography were monitored with an assessment of the steatosis and fibrosis degree. In case of SIBR presence, the probiotic Spazmolac, 1 capsule per day for 4 weeks, was added to the treatment. In 12 weeks after the treatment start, clinical, biochemical, sonographic indicators and SIBR were re-evaluated.Results. The use of L-Betargin in NAFLD for 12 weeks in a dose of 1 stick 3 times a day resulted in the significant suppression of cytolysis, a decrease in liver steatosis, an improvement in lipid metabolism and portal blood flow rates, and also reduction of the risk of developing or progression of atherosclerosis, cardiovascular diseases and insulin resistance.Conclusions. Due to its combined composition, synergy of mechanisms of action and normalization of metabolic disorders, L-Betargin contributes to the elimination of asthenic syndrome in patients with NAFLD and improves their quality of life. The four-week administration of the probiotic Spazmolac promoted almost two-fold SIBO reduction, that was accompanied by a significant decrease in the severity of abdominal pain, bloating and diarrhea. The use of L-Betargin resulted in the increased efficacy of SIBR eradication.
Source: Modern Gastroenterology
Authors: A. E. Dorofeyev, M. M. Rudenko, S. M. Tkach, Yu. Z. Dynia
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2964698405