Open AccessGut microbiota-related complications in cirrhosis
Author(s) -
Isabel GómezHurtado,
José Such,
Yolanda Sanz,
Ruben Francés
Publication year - 2014
Publication title -
world journal of gastroenterology
Language(s) - German
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v20.i42.15624
Subject(s) - spontaneous bacterial peritonitis , intestinal permeability , cirrhosis , gut flora , hepatic encephalopathy , small intestinal bacterial overgrowth , medicine , portal hypertension , immunology , intestinal mucosa , antibiotics , pathogenesis , sepsis , mesenteric lymph nodes , biology , gastroenterology , immune system , microbiology and biotechnology , irritable bowel syndrome
Gut microbiota plays an important role in cirrhosis. The liver is constantly challenged with commensal bacteria and their products arriving through the portal vein in the so-called gut-liver axis. Bacterial translocation from the intestinal lumen through the intestinal wall and to mesenteric lymph nodes is facilitated by intestinal bacterial overgrowth, impairment in the permeability of the intestinal mucosal barrier, and deficiencies in local host immune defences. Deranged clearance of endogenous bacteria from portal and systemic circulation turns the gut into the major source of bacterial-related complications. Liver function may therefore be affected by alterations in the composition of the intestinal microbiota and a role for commensal flora has been evidenced in the pathogenesis of several complications arising in end-stage liver disease such as hepatic encephalopathy, splanchnic arterial vasodilatation and spontaneous bacterial peritonitis. The use of antibiotics is the main therapeutic pipeline in the management of these bacteria-related complications. However, other strategies aimed at preserving intestinal homeostasis through the use of pre-, pro- or symbiotic formulations are being studied in the last years. In this review, the role of intestinal microbiota in the development of the most frequent complications arising in cirrhosis and the different clinical and experimental studies conducted to prevent or improve these complications by modifying the gut microbiota composition are summarized.