Targeting gut microbiota in liver disease: A pharmacological approach for hepatic encephalopathy and beyond

Figure 2 Rifaximin in hepatic encephalopathy. Rifaximin is a non-absorbable antibiotic that acts locally in the gut to modulate the intestinal microbiota. In patients with hepatic encephalopathy, this antibiotic reduces the abundance of ammonia-producing bacteria, leading to decreased production of ammonia and other gut-derived toxins. This reduction helps limit bacterial translocation and the associated release of proinflammatory cytokines. As a result fewer microbial products enter the portal circulation, contributing to decreased hepatic inflammation and potentially slowing the progression of liver fibrosis. Additionally, by lowering systemic levels of neurotoxic substances, rifaximin helps reduce neuroinflammation and improves cognitive function in patients with hepatic encephalopathy.