Gastrointestinal dysfunction in liver cirrhosis

Abstract

Patients with liver cirrhosis exhibit several features of gut dysfunction which may contribute to the development of cirrhosis complications as well as have an impact on nutritional status and health-related quality of life. Gastrointestinal symptoms are common in cirrhosis and their pathophysiology probably involves factors related to liver disease severity, psychological distress, and gut dysfunction (e.g., increased gastric sensitivity to distension and delayed gut transit). They may lead to reduced food intake and, thus, may contribute to the nutritional status deterioration in cirrhotic patients. Although tense ascites appears to have a negative impact on meal-induced accommodation of the stomach, published data on gastric accommodation in cirrhotics without significant ascites are not unanimous. Gastric emptying and small bowel transit have generally been shown to be prolonged. This may be related to disturbances in postprandial glucose, insulin, and ghrelin levels, which, in turn, appear to be associated to insulin resistance, a common finding in cirrhosis. Furthermore, small bowel manometry disturbances and delayed gut transit may be associated with the development of small bowel bacterial overgrowth. Finally, several studies have reported intestinal barrier dysfunction in patients with cirrhosis (especially those with portal hypertension), which is related to bacterial translocation and permeation of intestinal bacterial products, e.g., endotoxin and bacterial DNA, thus potentially being involved in the pathogenesis of complications of liver cirrhosis.

Keywords: Liver cirrhosis, Gut motility, Gastric accommodation, Malnutrition, Gastrointestinal symptoms, Intestinal permeability

Core tip: Features of gut dysfunction are common in patients with cirrhosis and may have an impact on quality of life and nutritional status as well as contribute to the development of cirrhosis complications. Cirrhotic patients often report gastrointestinal symptoms. Their pathophysiology is complex, probably involving factors related to liver disease severity, psychological distress, and increased gastric sensitivity to distension as well as delayed gut transit. The latter is common in cirrhosis and may be related to postprandial glucose and hormone disturbances due to insulin resistance. Intestinal barrier dysfunction, potentially leading to bacterial translocation and permeation of bacterial products, has been frequently reported in cirrhotic patients, especially those with portal hypertension.