Rifaximin plus probiotics reshape gut microbiota, serum propionate and mucosal immunity in cirrhosis-related hepatic encephalopathy
Adding a multistrain probiotic to rifaximin was associated with a graded reduction in serum ammonia and hepatic encephalopathy index compared with rifaximin alone or standard care.
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What the study showed
At 6 months, serum ammonia showed a stepwise decrease: standard care (177 μmol/L), rifaximin (143 μmol/L), rifaximin + probiotic (117 μmol/L). The exploratory HE index followed the same pattern (10.0, 5.3, 3.7). A mechanistic subset underwent 16S rRNA microbiome profiling, serum SCFA measurement, and fecal SIgA testing.
How it was done
Prospective, 6-month, randomized, open-label, assessor-blinded, three-arm controlled trial; 61 adults with cirrhosis-related HE allocated to standard care, rifaximin 550 mg twice daily, or rifaximin plus multistrain probiotic 1×10⁹ CFU three times daily.
Risk of bias
Small sample size (n=61, ~20 per arm) and open-label design limit inferential strength; the abstract does not report the mechanistic subset size or its full results, precluding evaluation of microbiological outcomes.
What this study does NOT prove
The study does not prove causality between microbiota/SCFA remodeling and clinical improvement, nor generalizability to other cirrhosis phenotypes or HE subtypes.
In clinical practice
Findings are preliminary and derived from a small trial; they do not support changes in clinical practice without replication in larger, adequately blinded studies.
Limitations
Small sample size (n=61, ~20 per arm) and open-label design limit inferential strength; the abstract does not report the mechanistic subset size or its full results, precluding evaluation of microbiological outcomes.
Technical appendix
Version history
- 1.0 · 2026-07-15 — Auto-generated under Evidence Standard v1.0
Paid access: structured summary from public metadata; consult the original study at the source.