Clinical efficacy of probiotics in the treatment of alcoholic liver disease: a systematic review and meta-analysis

Systematic review and meta-analysis of 9 controlled studies in adults with alcoholic liver disease, including alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis, conducted in multiple countries. The active intervention arms were compared with control groups across short-term treatment periods.

Across the included trials, the active intervention was probiotic supplementation using different strains or combinations, including Lacticaseibacillus rhamnosus R0011 plus Lactobacillus helveticus R0052, Lactobacillus subtilis/Streptococcus faecium, Lactobacillus casei Shirota YIT 9029, Lactobacillus casei, Lactobacillus rhamnosus GG, Bifidobacterium bifidum plus Lactobacillus plantarum 8PA3, and mixed Bifidobacteria/Lactobacilli/Enterococcus preparations. Intervention duration ranged from 7 to 60 days; specific doses, frequencies, and routes were not reported in the provided text.

Probiotic supplementation improved liver function and serum albumin in patients with alcoholic liver disease. Compared with control, probiotics significantly reduced ALT (MD = -13.36, 95% CI: -15.80, -10.91; P < 0.00001), AST (MD = -16.99, 95% CI: -20.38, -13.59; P < 0.00001), and GGT (MD = -18.79, 95% CI: -28.23, -9.34; P < 0.0001), and increased albumin (MD = 0.19, 95% CI: 0.02, 0.36; P = 0.03). Bilirubin was not significantly different, inflammatory markers were inconsistent, and no serious adverse events were reported. The authors concluded that probiotics may have a beneficial therapeutic effect in ALD, potentially through modulation of gut microbiota and endotoxin reduction, but more high-quality trials are needed.

The evidence base was small and heterogeneous, with different probiotic strains or combinations, varied ALD subtypes, and short treatment durations of 7 to 60 days. Some outcomes showed inconsistency or substantial heterogeneity, limiting confidence in the magnitude and generalizability of the effect.