TY - JOUR

T1 - Utilizing the gut microbiome in decompensated cirrhosis and acute-on-chronic liver failure

AU - Trebicka, Jonel

AU - Bork, Peer

AU - Krag, Aleksander

AU - Arumugam, Manimozhiyan

PY - 2021

Y1 - 2021

N2 - The human gut microbiome has emerged as a major player in human health and disease. The liver, as the first organ to encounter microbial products that cross the gut epithelial barrier, is affected by the gut microbiome in many ways. Thus, the gut microbiome might play a major part in the development of liver diseases. The common end stage of liver disease is decompensated cirrhosis and the further development towards acute-on-chronic liver failure (ACLF). These conditions have high short-term mortality. There is evidence that translocation of components of the gut microbiota, facilitated by different pathogenic mechanisms such as increased gut epithelial permeability and portal hypertension, is an important driver of decompensation by induction of systemic inflammation, and thereby also ACLF. Elucidating the role of the gut microbiome in the aetiology of decompensated cirrhosis and ACLF deserves further investigation and improvement; and might be the basis for development of diagnostic and therapeutic strategies. In this Review, we focus on the possible pathogenic, diagnostic and therapeutic role of the gut microbiome in decompensation of cirrhosis and progression to ACLF.The common end stage of liver disease is decompensated cirrhosis and the further development towards acute-on-chronic liver failure. In this Review, the authors discuss the possible pathogenic, diagnostic and therapeutic role of the gut microbiota in decompensation of cirrhosis and progression to acute-on-chronic liver failure.

AB - The human gut microbiome has emerged as a major player in human health and disease. The liver, as the first organ to encounter microbial products that cross the gut epithelial barrier, is affected by the gut microbiome in many ways. Thus, the gut microbiome might play a major part in the development of liver diseases. The common end stage of liver disease is decompensated cirrhosis and the further development towards acute-on-chronic liver failure (ACLF). These conditions have high short-term mortality. There is evidence that translocation of components of the gut microbiota, facilitated by different pathogenic mechanisms such as increased gut epithelial permeability and portal hypertension, is an important driver of decompensation by induction of systemic inflammation, and thereby also ACLF. Elucidating the role of the gut microbiome in the aetiology of decompensated cirrhosis and ACLF deserves further investigation and improvement; and might be the basis for development of diagnostic and therapeutic strategies. In this Review, we focus on the possible pathogenic, diagnostic and therapeutic role of the gut microbiome in decompensation of cirrhosis and progression to ACLF.The common end stage of liver disease is decompensated cirrhosis and the further development towards acute-on-chronic liver failure. In this Review, the authors discuss the possible pathogenic, diagnostic and therapeutic role of the gut microbiota in decompensation of cirrhosis and progression to acute-on-chronic liver failure.

KW - SPONTANEOUS BACTERIAL PERITONITIS

KW - DECREASES INTESTINAL PERMEABILITY

KW - VENOUS-PRESSURE GRADIENT

KW - PORTAL-VEIN THROMBOSIS

KW - SECONDARY BILE-ACIDS

KW - HEPATIC-ENCEPHALOPATHY

KW - SYSTEMIC INFLAMMATION

KW - RIFAXIMIN IMPROVES

KW - TRANSLOCATION

KW - ALBUMIN

U2 - 10.1038/s41575-020-00376-3

DO - 10.1038/s41575-020-00376-3

M3 - Review

C2 - 33257833

VL - 18

SP - 167

EP - 180

JO - Nature Reviews. Gastroenterology & Hepatology

JF - Nature Reviews. Gastroenterology & Hepatology

SN - 1759-5045

ER -