Gastrointestinal tract in liver disease: which organ is sick?
OBJECTIVE
This article gives an overview of the several morphological and functional alterations in the gastrointestinal tract that occur in liver disease and their systemic impact.


RESULTS
Recent endoscopic studies have revealed similar mucosal alterations in the upper gastrointestinal as well as the colon that include inflammatory-like changes and vascular lesions. Gut-barrier integrity is consequently impaired. There is an evidence that bacterial translocation with subsequent endotoxaemia provokes an inflammatory response that might trigger the cachexia syndrome in liver disease. Novel therapeutic approaches that address gut-barrier function such as supplementation with insulin-like growth factor or synbiotics have shown promising results.


CONCLUSIONS
There are various alterations of the gastrointestinal tract in liver disease and portal hypertension, which might be less clinically overt than the cardinal potentially life-threatening features, ascites and oesophageal varices. However, these alterations, for example gut-barrier dysfunction and alterations of gut flora (microbiota) have immense impact on the portal enteropathy, as they both contribute to the systemic inflammation in liver cirrhosis, which is considered a risk factor for infections as well as the development of cachexia.
Norman
Kristina
K
Medizinische Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, CCM, Charitéplatz 1, Berlin, Germany.
Pirlich
Matthias
M
D018988:Bacterial Translocation; D002100:Cachexia / Q000209:etiology; D019446:Endotoxemia; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology*; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000503:physiopathology; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology*; D019936:Probiotics / Q000627:therapeutic use
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I