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World J Hepatol. Sep 27, 2021; 13(9): 1154-1166
Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1154
Probiotics in hepatology: An update
Roman Maslennikov, Vladimir Ivashkin, Irina Efremova, Elena Poluektova, Elena Shirokova
Roman Maslennikov, Vladimir Ivashkin, Irina Efremova, Elena Poluektova, Elena Shirokova, Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia
Roman Maslennikov, Vladimir Ivashkin, Elena Poluektova, Scientific Community for Human Microbiome Research, Moscow 119435, Russia
Roman Maslennikov, Department of Internal Medicine, Consultative and Diagnostic Center of the Moscow City Health Department, Moscow 107564, Russia
Author contributions: The idea of the manuscript is by Ivashkin V and Maslennikov R; each author wrote specific sections of the manuscript; all authors took part in the editing of the final manuscript and approved it.
Conflict-of-interest statement: Dr. Maslennikov reports a grant from by Biocodex Microbiota Foundation (National Research Grant Russia 2019) outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roman Maslennikov, MD, PhD, Professor, Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Pogodinsckays str. 1-1, Moscow 119435, Russia. mmmm00@yandex.ru
Received: May 19, 2021
Peer-review started: May 19, 2021
First decision: June 4, 2021
Accepted: August 16, 2021
Article in press: August 16, 2021
Published online: September 27, 2021
Abstract

The gut–liver axis plays an important role in the pathogenesis of various liver diseases. Probiotics are living bacteria that may be used to correct disorders of this axis. Notable progress has been made in the study of probiotic drugs for the treatment of various liver diseases in the last decade. It has been proven that probiotics are useful for hepatic encephalopathy, but their effects on other symptoms and syndromes of cirrhosis are poorly studied. Their effectiveness in the treatment of metabolic associated fatty liver disease has been shown both in experimental models and in clinical trials, but their effect on the prognosis of this disease has not been described. The beneficial effects of probiotics in alcoholic liver disease have been shown in many experimental studies, but there are very few clinical trials to support these findings. The effects of probiotics on the course of other liver diseases are either poorly studied (such as primary sclerosing cholangitis, chronic hepatitis B and C, and autoimmune hepatitis) or not studied at all (such as primary biliary cholangitis, hepatitis A and E, Wilson's disease, hemochromatosis, storage diseases, and vascular liver diseases). Thus, despite the progress in the study of probiotics in hepatology over the past decade, there are many unexplored and unclear questions surrounding this topic.

Keywords: Gut-liver axis, Pathogenesis, Gut dysbiosis, Gut microbiota, Gut microbiome, Liver disease, Probiotics, Hepatic encephalopathy, Cirrhosis, Metabolic associated fatty liver disease, Alcoholic liver disease, Primary sclerosing cholangitis

Core Tip: Probiotics are useful for hepatic encephalopathy, but their effects on other symptoms and syndromes of cirrhosis are poorly studied. Their effectiveness in the treatment of metaboliс associated fatty liver disease has been shown both in experimental models and in clinical trials, but their effect on the prognosis of this disease has not been described. The beneficial effects of probiotics in alcoholic liver disease have been shown in many experimental studies, but there are very few clinical trials to support these findings. The effects of probiotics on the course of other liver diseases are either poorly studied or not studied at all.