Altered Microbiome in Patients With Cirrhosis and Complications

被引:108
作者
Acharya, Chathur [1 ,2 ]
Bajaj, Jasmohan S. [1 ,2 ]
机构
[1] Virginia Commonwealth Univ, Div Gastroenterol Hepatol & Nutr, 1201 Broad Rock Blvd, Richmond, VA 23249 USA
[2] McGuire VA Med Ctr, 1201 Broad Rock Blvd, Richmond, VA 23249 USA
关键词
Outcomes; Dysbiosis; Oral; Hepatic Encephalopathy; Fecal Microbial Transplant; INTESTINAL BACTERIAL OVERGROWTH; CHRONIC LIVER-FAILURE; NECROSIS-FACTOR-ALPHA; HUMAN GUT MICROBIOME; HEPATIC-ENCEPHALOPATHY; ALCOHOLIC CIRRHOSIS; FECAL MICROBIOTA; CLINICAL-COURSE; INFECTIONS; DYSBIOSIS;
D O I
10.1016/j.cgh.2018.08.008
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
In patients with cirrhosis, the gut microbiome are affected by multiple gut and systemic alterations. These changes lead to dysbiosis in the microbiota of different parts of the body, resulting in inflammation. The constant immune stimulation resulting in part from dysbiosis is associated with morbidity in patients with cirrhosis. Dysbiosis as a dynamic event worsens with decompensation such as with hepatic encephalopathy, infections or acute-on-chronic liver failure (ACLF). These microbial patterns could be applied as diagnostic and prognostic measures in cirrhosis in the outpatient and inpatient setting. Current therapies for cirrhosis have differing impacts on gut microbial composition and functionality. Dietary modifications and the oral cavity have emerged as newer targetable factors to modulate the microbiome, which could affect inflammation and, potentially improve outcomes. Additionally, fecal microbial transplant is being increasingly studied to provide compositional and functional modulation of the microbiome. Ultimately, a combination of targeted therapies may be needed to provide an optimal gut milieu to improve outcomes in cirrhosis.
引用
收藏
页码:307 / 321
页数:15
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