The Efficacy of Gut Microbiome–Modulating Therapies on Liver Cirrhosis: A Systematic Review and Network Meta-Analysis
Abstract
INTRODUCTION: Gut microbiome–modulating therapies are potential strategies for managing liver cirrhosis, yet head-to-head comparisons to determine the optimal intervention are lacking. This study aimed to evaluate and rank the therapeutic efficacy of these therapies on liver function and disease progression in patients with liver cirrhosis. METHODS: We searched major databases (PubMed, Web of Science, Embase, Cochrane Library) for randomized controlled trials (RCTs) published from January 1, 2000, to December 30, 2024. Interventions included probiotics, prebiotics, synbiotics, and fecal microbiota transplantation vs placebo or standard care. Primary outcomes were hepatic function indicators; secondary outcomes included inflammatory markers. Data were analyzed using random-effects frequentist network meta-analyses. The study was registered on Prospective Register of Systematic Reviews (CRD420251000506). RESULTS: Seventeen studies comprising 1,051 individuals were included. Synbiotics demonstrated the most significant efficacy among all interventions, showing superior reduction in blood ammonia levels compared with placebo (mean difference [MD] −5.57), probiotics, and prebiotics. Prebiotics showed significant differences in lowering endotoxin levels compared with placebo (MD: −3.29) and probiotics. Furthermore, relative to placebo, prebiotics significantly reduced tumor necrosis factor-alpha (MD: −2.30) and interleukin-6 levels (MD: −4.60). DISCUSSION: This network…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,051 participants or records.
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