Intestinal permeability and bacterial growth of the small bowel in patients with primary sclerosing cholangitis

Abstract

Small intestinal bacterial overgrowth and increased intestinal permeability does not seem to play an important pathogenic role in patients with primary sclerosing cholangitis.

Effects of Antibiotics on Gut Microbiota

“…[63]. Consistent with the role of a leaky gut as a driver of hepatic inflammation in PSC [64], antibiotic treatment improved biochemical or histological activity in some studies [65,66,67]. However, we do not know whether a change in gut microbiota composition or the treatment of biliary infections is causative.…”

Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis ‐ a pilot study

“…One line of evidence that supports the PSC microbiota hypothesis is that bacterially derived molecules such as lipopolysaccharide (LPS), lipoteichoic acid and bacterial DNA fragments have been detected in bile, cholangiocytes and/or portal tracts of patients with chronic cholestatic liver disease. [40][41][42][43] It is believed that these molecules enter the enterohepatic circulation via a leaky gut, although this has been questioned based on a study that failed to show increased intestinal permeability in adults with PSC 44 ; it should be noted though, that none of the patients in the study had active IBD, thus this remains a subject of uncertainty. With respect to animal models, it has been shown that rodents with bacterial and/or chemically induced enterocolitis develop hepatobiliary inflammation and histological injury (e.g.…”

Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary Candidiasis

“…Several studies demonstrated that pathogenic antigens infiltrating the liver are capable of inducing hepatobiliary inflammation with numerous features of PSC. In particular, the increased enterohepatic circulation of pathogenic antigens as a consequence of abnormal intestinal permeability can contribute to the pathogenesis of PSC [15,24,25]. In this regard, portal bacteremia and bacterobilia were demonstrated in PSC patients with concomitant IBD [26].…”