Bacterial translocation in patients with liver cirrhosis: physiology, clinical consequences, and practical implications

Abstract

The gut liver axis is an operative unit that works to protect the human body against potentially harmful substances and microorganisms, maintaining the homeostasis of the immune system. Liver cirrhosis profoundly alters this complex system. The intestine becomes more permeable allowing the translocation of bacteria, bacterial products and fragments into the portal circulation, triggering an abnormal local and systemic inflammatory response and a condition of perpetual immunologic alarm. This immune-inflammatory disorder related to dysbiosis is involved in the development of liver damage and liver cirrhosis complications and increases intestinal permeability in a vicious circle. Areas covered: The most relevant studies on bacterial translocation, the mechanism of intestinal barrier dysfunction and its consequences in patients with liver cirrhosis have been revised through a PubMed search. Data have been discussed with particular regard to their significance in clinical practice. Expert commentary: The assessment of bacterial translocation and intestinal permeability is not currently used in clinical practice but may be useful to stratify patients' prognosis.

Increased Colonic Permeability and Lifestyles as Contributing Factors to Obesity and Liver Steatosis

“…NAFLD children had increased ratio in urinary excretion of orally administered lactulose and mannitol (L/M ratio), as a marker of intestinal permeability [70,77,81]. L/M ratio further increased in NASH patients.…”

The impact of HBV flare on the outcome of HBV‐related decompensated cirrhosis patients with bacterial infection

“…Bacterial infection (BI) occurs in 25%‐35% of patients with cirrhosis admitted into the hospital, which is 4‐5 fold higher than that observed in populations without cirrhosis . Patients with decompensated cirrhosis have an increased risk of developing BI because of increased bacterial translocation; coupled with their relative immuno‐compromised state, which reduces their ability to fight against infection . Once BI occurs, patients with cirrhosis are at risk of increased morbidity and mortality, related to an exaggerated reaction between the host and the various bacteria and their products, or the so‐called pathogen‐associated molecular patterns (PAMPs), triggering inflammation, thereby resulting in tissue damage and organ failure …”

Antifibrotic Effects of a Barbituric Acid Derivative on Liver Fibrosis by Blocking the NF-κB Signaling Pathway in Hepatic Stellate Cells

“…Liver fibrosis is tightly associated with chronic liver inflammation. After liver injury, intestinal mucosal permeability and bacterial translocation are increased and lead to elevated LPS levels in the portal and systemic circulation (Ponziani et al, 2018). A previous study found that LPS was increased in hepatic fibrosis mouse models and cirrhosis patients (Wiest and Garcia-Tsao, 2005;Pradere et al, 2010).…”