Effect of a Probiotic and Metformin on Liver Aminotransferases in Non-alcoholic Steatohepatitis: A Double Blind Randomized Clinical Trial

Background: non-alcoholic steatohepatitis (nash) is a clinicopathological entity that is being recognized more frequently in recent years. this study aimed to evaluate the effects of metformin, with and without a probiotic supplement on liver aminotransferases in patients with nash. methods: sixty four patients 18-75 years with nash confi rmed by biopsy and histological assessment were enrolled to study. patients were randomized to one of the following treatments for 6 months: group i, probiotic (protexin two tablets per day) plus metformin 500 mg two tablets per day (met/pro), or group ii, metformin 500 mg two tablets per day plus two placebo tablet (met/p). after 6 month alanine aminotransferase (alt), aspartate aminotransferase, and ultrasound grading of nash were assessed.results: in group i, serum alanine aminotransferase (alt: 133.7 ±70 vs. 45.2 ± 32.5; p < 0.00), and aspartate aminotransferase activity (ast: 123.1 ± 72 vs. 44.2 ± 33.9; p < 0.001), and ultrasound grading of nash (p < 0.001) all decreased signifi cantly by the end of the treatment period. in group ii, while serum alanine aminotransferase (alt) was not signifi cantly reduced (118.4 ± 67.9 vs. 112.5 ± 68.7; p < 0.064), aspartate aminotransferase activity (ast: 125.3 ± 71 vs. 113.4 ± 71; p < 0.001), and ultrasound grading of nash did fall signifi cantly (p < 0.01). body mass index (bmi), fasting blood sugar (fbs), cholesterol, and triglyceride fell signifi cantly in both group conclusions: probiotic combination with metformin improves liver aminotransferases better than metformin alone in patients with nash.