Abstract
Recent breakthrough in our understanding pertaining to the pathogenesis of nonalcoholic fatty liver disease (NAFLD) has pointed to dysregulation or derangement of the gut microbiome, also known as dysbiosis. This has led to growing interest in probiotic supplementation as a potential treatment method for NAFLD due to its ability to retard and/or reverse dysbiosis and restore normal gut flora. A thorough review of medical literature was completed from inception through July 10, 2018 on the PubMed database by searching for key terms such as NAFLD, probiotics, dysbiosis, synbiotics, and nonalcoholic steatohepatitis (NASH). All studies reviewed indicate that probiotics had a beneficial effect in patients with NAFLD and its subset NASH. Results varied between studies, but there was evidence demonstrating improvement in liver enzymes, hepatic inflammation, hepatic steatosis, and hepatic fibrosis. No major adverse effects were noted. Currently, there are no guidelines addressing the use of probiotics in the setting of NAFLD. In conclusion, probiotics appear to be a promising option in the treatment of NAFLD. Future research is necessary to assess the efficacy of probiotics in patients with NAFLD.
Highlights
Nonalcoholic fatty liver disease (NAFLD) and its progressive subset, nonalcoholic steatohepatitis (NASH), affect a significant proportion of the population
Current research has indicated that there is a clear association between the dysbiosis of the gut and occurrence of nonalcoholic fatty liver disease (NAFLD); future clarity is necessary as to whether this relation is causal and the mechanism by which dysbiosis plays a role in NAFLD pathogenesis
Inflammation occurs mostly through the activated toll-like receptors (TLRs) of various hepatic cells [18]. These TLRs are normally inactive in healthy liver cells and are pattern recognition receptors that bind pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) [21]
Summary
Nonalcoholic fatty liver disease (NAFLD) and its progressive subset, nonalcoholic steatohepatitis (NASH), affect a significant proportion of the population. The focus of this article is to review the role of the gut microbiome and probiotics in patients with NAFLD and its progressive subset nonalcoholic steatohepatitis (NASH). Recent research has linked changes in the gut microbiome with the pathogenesis of NAFLD [4]. The ability of probiotics to re-establish a natural and healthy gut microbiome makes them a promising therapeutic option for patients with NAFLD; the American Association for the Study of Liver. Disease (AASLD) and the European Association for the Study of the Liver (EASL) currently have no guidelines regarding the role of probiotics in patients with NAFLD and/or NASH [2].
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