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

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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.

Original languageEnglish
JournalNature Reviews Gastroenterology & Hepatology
Volume18
Pages (from-to)167-180
Number of pages14
ISSN1759-5045
DOIs
Publication statusPublished - 2021

    Research areas

  • SPONTANEOUS BACTERIAL PERITONITIS, DECREASES INTESTINAL PERMEABILITY, VENOUS-PRESSURE GRADIENT, PORTAL-VEIN THROMBOSIS, SECONDARY BILE-ACIDS, HEPATIC-ENCEPHALOPATHY, SYSTEMIC INFLAMMATION, RIFAXIMIN IMPROVES, TRANSLOCATION, ALBUMIN

ID: 253447346