title: Implication of the intestinal microbiome in complications of cirrhosis.
abstract: The intestinal microbiome (IM) is altered in patients with cirrhosis, and emerging literature suggests that this impacts on the development of complications. The PubMed database was searched from January 2000 to May 2015 for studies and review articles on the composition, pathophysiologic effects and therapeutic modulation of the IM in cirrhosis. The following combination of relevant text words and MeSH terms were used, namely intestinal microbiome, microbiota, or dysbiosis, and cirrhosis, encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome, portopulmonary hypertension and hepatocellular carcinoma. The search results were evaluated for pertinence to the subject of IM and cirrhosis, as well as for quality of study design. The IM in cirrhosis is characterized by a decreased proportion ofBacteroidesandLactobacilli, and an increased proportion ofEnterobacteriaceaecompared to healthy controls. Except for alcoholic cirrhosis, the composition of the IM in cirrhosis is not affected by the etiology of the liver disease. The percentage ofEnterobacteriaceaeincreases with worsening liver disease severity and decompensation and is associated with bacteremia, spontaneous bacterial peritonitis and hepatic encephalopathy. Lactulose, rifaximin and Lactobacillus-containing probiotics have been shown to partially reverse the cirrhosis associated enteric dysbiosis, in conjunction with improvement in encephalopathy. The IM is altered in cirrhosis, and this may contribute to the development of complications associated with end-stage liver disease. Therapies such as lactulose, rifaximin and probiotics may, at least partially, reverse the cirrhosis-associated changes in the IM. This, in turn, may prevent or alleviate the severity of complications.
authors.affiliation: Mamatha Bhat, Bianca M Arendt, Eberhard L Renner, Johane P Allard, Division of Gastroenterology, University Health Network, Toronto M5G 2N2, Canada.
authors.forename: Mamatha
authors.initials: M
authors.lastname: Bhat
authors.affiliation: Mamatha Bhat, Bianca M Arendt, Eberhard L Renner, Johane P Allard, Division of Gastroenterology, University Health Network, Toronto M5G 2N2, Canada.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Arendt
authors.affiliation: Mamatha Bhat, Bianca M Arendt, Eberhard L Renner, Johane P Allard, Division of Gastroenterology, University Health Network, Toronto M5G 2N2, Canada.
authors.forename: Venkat
authors.initials: V
authors.lastname: Bhat
authors.affiliation: Mamatha Bhat, Bianca M Arendt, Eberhard L Renner, Johane P Allard, Division of Gastroenterology, University Health Network, Toronto M5G 2N2, Canada.
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
authors.affiliation: Mamatha Bhat, Bianca M Arendt, Eberhard L Renner, Johane P Allard, Division of Gastroenterology, University Health Network, Toronto M5G 2N2, Canada.
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.affiliation: Mamatha Bhat, Bianca M Arendt, Eberhard L Renner, Johane P Allard, Division of Gastroenterology, University Health Network, Toronto M5G 2N2, Canada.
authors.forename: Johane P
authors.initials: JP
authors.lastname: Allard
keywords: Cirrhosis; Encephalopathy; Intestinal microbiome