title: Intestinal epithelial barrier function in liver cirrhosis: an extensive review of the literature.
abstract: Recent evidence suggests that translocation of bacteria and bacterial products, such as endotoxin from the intestinal lumen into the systemic circulation is a contributing factor in the pathogenesis of chronic liver diseases and the development of complications in cirrhosis. In addition to alterations in the intestinal microbiota and immune system, dysfunction of the intestinal epithelial barrier may be an important factor facilitating bacterial translocation. This review aims to provide an overview of the current evidence of intestinal epithelial barrier dysfunction in human chronic liver diseases and cirrhosis, and to discuss possible contributing factors and mechanisms. Data suggest the presence of intestinal epithelial barrier dysfunction in patients with chronic liver diseases, but are more convincing in patients with cirrhosis, especially in those with complications. The barrier dysfunction can result from both direct and indirect effects of aetiological factors, such as alcohol and obesity, which can cause chronic liver diseases and ultimately cirrhosis. On the other hand characteristics of cirrhosis itself, including portal hypertension, alterations in the intestinal microbiota, inflammation and oxidative stress can affect barrier function of both small and large intestine and may contribute to the development of complications. In conclusion, there are indications for intestinal epithelial barrier dysfunction in patients with chronic liver diseases and especially in patients with cirrhosis, which can be caused by various factors affecting both the small and large intestine.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands; School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Pijls
authors.forename: Daisy M A E
authors.initials: DM
authors.lastname: Jonkers
authors.forename: Elhaseen E
authors.initials: EE
authors.lastname: Elamin
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
authors.forename: Ger H
authors.initials: GH
authors.lastname: Koek
mesh_terms: D018988:Bacterial Translocation / Q000502:physiology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000473:pathology*; D007413:Intestinal Mucosa / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D018384:Oxidative Stress / Q000502:physiology; D010539:Permeability
keywords: Bacterial translocation; cirrhosis; endotoxins; epithelial barrier; intestine; liver; microbiota; permeability; tight junctions