Objective To review and analyze the effect of probiotics in preventing the overt hepatic encephalopathy (OHE) in patients with minimal hepatic encephalopathy (MHE). Methods Studies about this subject were searched in PubMed, Web of Science, Cochrane Library, Chinese journal full-text database (CNKI), WanFang data knowledge service platform (WanFang Data) from their establishment to November 2021. Meta-analysis was performed using RevMan 5.4. Description analysis was used for data that could not be pooled. The relative risk ( RR ) and 95% confidence interval ( CI ) were used to present pooled data. Results Six RCT studies with a total of 404 patients were included in this meta-analysis. The results showed probiotics users had a significant reduction of the OHE incidence, as compared with the controls ( RR =0.46, 95% CI : 0.26 - 0.81; P =0.007), but an increase in the reversal MHE rate ( RR =4.94, 95% CI : 2.82-8.66; P < 0.000 01). Conclusion This finding demonstrated that probiotics were able to effectively reduce the OHE incidence and improve the reversal MHE rate in the patients with MHE. This study could provide novel evidence for probiotics treatment of MHE.

Proton pump inhibitors (PPIs) are commonly used in clinical practice and are currently widely used in people with acute-on-chronic liver failure (ACLF). However, such medication is still not supported by the recommendations in the latest version of Clinical guidelines for acute-on-chronic liver failure issued by American College of Gastroenterology. With reference to the guidelines or consensus statements in China and globally and the latest research advances, this article elaborates on the indications, possible benefits, and potential risks of PPIs used in people with ACLF, in order to provide a reference for the standardized use of PPIs in the population with ACLF in clinical practice.