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Implication of the intestinal microbiome in complications of cirrhosis

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ABSTRACT

The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma. The search results were evaluated for pertinence to the subject of IM and cirrhosis, as well as for quality of study design. The IM in cirrhosis is characterized by a decreased proportion of Bacteroides and Lactobacilli, and an increased proportion of Enterobacteriaceae compared to healthy controls. Except for alcoholic cirrhosis, the composition of the IM in cirrhosis is not affected by the etiology of the liver disease. The percentage of Enterobacteriaceae increases with worsening liver disease severity and decompensation and is associated with bacteremia, spontaneous bacterial peritonitis and hepatic encephalopathy. Lactulose, rifaximin and Lactobacillus-containing probiotics have been shown to partially reverse the cirrhosis associated enteric dysbiosis, in conjunction with improvement in encephalopathy. The IM is altered in cirrhosis, and this may contribute to the development of complications associated with end-stage liver disease. Therapies such as lactulose, rifaximin and probiotics may, at least partially, reverse the cirrhosis-associated changes in the IM. This, in turn, may prevent or alleviate the severity of complications.

No MeSH data available.


Factors influencing intestinal microbiome composition in cirrgosis. IM: Intestinal microbiome.
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Figure 1: Factors influencing intestinal microbiome composition in cirrgosis. IM: Intestinal microbiome.

Mentions: Patients with cirrhosis have both qualitative and quantitative changes in their gut microbiota[45-47]. Small intestinal bacterial overgrowth, defined as > 105 CFU/mL and/or the presence of colonic bacteria in upper jejunal aspirate, is present in 48% to 73% of cirrhotic patients[48,49]. Impaired small intestinal motility[50], decreased bile flow[51], and dysregulated secretion of immunoglobulin A[51] and antimicrobial molecules[52] all contribute to small intestinal bacterial overgrowth in patients with cirrhosis (Figure 1).


Implication of the intestinal microbiome in complications of cirrhosis
Factors influencing intestinal microbiome composition in cirrgosis. IM: Intestinal microbiome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037326&req=5

Figure 1: Factors influencing intestinal microbiome composition in cirrgosis. IM: Intestinal microbiome.
Mentions: Patients with cirrhosis have both qualitative and quantitative changes in their gut microbiota[45-47]. Small intestinal bacterial overgrowth, defined as > 105 CFU/mL and/or the presence of colonic bacteria in upper jejunal aspirate, is present in 48% to 73% of cirrhotic patients[48,49]. Impaired small intestinal motility[50], decreased bile flow[51], and dysregulated secretion of immunoglobulin A[51] and antimicrobial molecules[52] all contribute to small intestinal bacterial overgrowth in patients with cirrhosis (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma. The search results were evaluated for pertinence to the subject of IM and cirrhosis, as well as for quality of study design. The IM in cirrhosis is characterized by a decreased proportion of Bacteroides and Lactobacilli, and an increased proportion of Enterobacteriaceae compared to healthy controls. Except for alcoholic cirrhosis, the composition of the IM in cirrhosis is not affected by the etiology of the liver disease. The percentage of Enterobacteriaceae increases with worsening liver disease severity and decompensation and is associated with bacteremia, spontaneous bacterial peritonitis and hepatic encephalopathy. Lactulose, rifaximin and Lactobacillus-containing probiotics have been shown to partially reverse the cirrhosis associated enteric dysbiosis, in conjunction with improvement in encephalopathy. The IM is altered in cirrhosis, and this may contribute to the development of complications associated with end-stage liver disease. Therapies such as lactulose, rifaximin and probiotics may, at least partially, reverse the cirrhosis-associated changes in the IM. This, in turn, may prevent or alleviate the severity of complications.

No MeSH data available.