The effects of chronic alcohol consumption on the bowel flora and the potential therapeutic
role of probiotics in alcohol-induced liver injury have not previously been evaluated.
In this study, 66 adult Russian males admitted to a psychiatric hospital with a diagnosis
of alcoholic psychosis were enrolled in a prospective, randomized, clinical trial
to study the effects of alcohol and probiotics on the bowel flora and alcohol-induced
liver injury. Patients were randomized to receive 5 days of Bifidobacterium bifidum
and Lactobacillus plantarum 8PA3 versus standard therapy alone (abstinence plus vitamins).
Stool cultures and liver enzymes were performed at baseline and again after therapy.
Results were compared between groups and with 24 healthy, matched controls who did
not consume alcohol. Compared to healthy controls, alcoholic patients had significantly
reduced numbers of bifidobacteria (6.3 vs. 7.5 log colony-forming unit [CFU]/g), lactobacilli
(3.15 vs. 4.59 log CFU/g), and enterococci (4.43 vs. 5.5 log CFU/g). The mean baseline
alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl
transpeptidase (GGT) activities were significantly elevated in the alcoholic group
compared to the healthy control group (AST: 104.1 vs. 29.15 U/L; ALT: 50.49 vs. 22.96
U/L; GGT 161.5 vs. 51.88 U/L), indicating that these patients did have mild alcohol-induced
liver injury. After 5 days of probiotic therapy, alcoholic patients had significantly
increased numbers of both bifidobacteria (7.9 vs. 6.81 log CFU/g) and lactobacilli
(4.2 vs. 3.2 log CFU/g) compared to the standard therapy arm. Despite similar values
at study initiation, patients treated with probiotics had significantly lower AST
and ALT activity at the end of treatment than those treated with standard therapy
alone (AST: 54.67 vs. 76.43 U/L; ALT 36.69 vs. 51.26 U/L). In a subgroup of 26 subjects
with well-characterized mild alcoholic hepatitis (defined as AST and ALT greater than
30 U/L with AST-to-ALT ratio greater than one), probiotic therapy was associated with
a significant end of treatment reduction in ALT, AST, GGT, lactate dehydrogenase,
and total bilirubin. In this subgroup, there was a significant end of treatment mean
ALT reduction in the probiotic arm versus the standard therapy arm. In conclusion,
patients with alcohol-induced liver injury have altered bowel flora compared to healthy
controls. Short-term oral supplementation with B. bifidum and L. plantarum 8PA3 was
associated with restoration of the bowel flora and greater improvement in alcohol-induced
liver injury than standard therapy alone.