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World J Gastroenterol. Dec 7, 2014; 20(45): 16795-16810
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16795
Microbiota and the gut-liver axis: Bacterial translocation, inflammation and infection in cirrhosis
Valerio Giannelli, Vincenza Di Gregorio, Valerio Iebba, Michela Giusto, Serena Schippa, Manuela Merli, Ulrich Thalheimer
Valerio Giannelli, Vincenza Di Gregorio, Michela Giusto, Manuela Merli, Gastroenterology Department of Clinical Medicine, Sapienza University of Rome, 00185 Rome, Italy
Valerio Iebba, Serena Schippa, Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Ulrich Thalheimer, The Exeter Liver Unit, Royal Devon and Exeter Foundation Trust, Exeter EX2 5DW, United Kingdom
Author contributions: Merli M and Thalheimer U have equally contributed as senior authors; all authors contributed in writing and revising the manuscript.
Correspondence to: Manuela Merli, Professor, Gastroenterology Department of Clinical Medicine, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy. manuela.merli@uniroma1.it
Telephone: +39-6-49972004 Fax: +39-6-4453319
Received: May 29, 2014
Revised: July 26, 2014
Accepted: September 29, 2014
Published online: December 7, 2014
Abstract

Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota. In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic bacteria (i.e., gram negative species) and a decrease in autochthonous familiae. Here we summarize the available literature on the risk of gut dysbiosis in liver cirrhosis and its clinical consequences. We therefore described the features of the complex interaction between gut microbiota and cirrhotic host, the so called “gut-liver axis”, with a particular attention to the acquired risk of bacterial translocation, systemic inflammation and the relationship with systemic infections in the cirrhotic patient. Such knowledge might help to develop novel and innovative strategies for the prevention and therapy of gut dysbiosis and its complication in liver cirrhosis.

Keywords: Dysbiosis, Cirrhosis, Bacterial translocation, Inflammation, Infection, Bacterial overgrowth, Rifaximine, Lactulose, Liver, Gut, Portal hypertension

Core tip: In this review we reported the most recent concepts on the complex interaction between gut microbiota and cirrhotic host, namely the gut-liver axis. We focused our attention to the clinical consequences of gut dysbiosis in cirrhosis such as the acquired risk of bacterial translocation, systemic inflammation and the relationship with systemic infections.