Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2018; 24(34): 3813-3820
Published online Sep 14, 2018. doi: 10.3748/wjg.v24.i34.3813
Clinical impact of microbiome in patients with decompensated cirrhosis
Theodora Oikonomou, George V Papatheodoridis, Michael Samarkos, Ioannis Goulis, Evangelos Cholongitas
Theodora Oikonomou, Ioannis Goulis, Fourth Department of Internal Medicine, Hippokration General Hospital, Medical School of Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
George V Papatheodoridis, Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
Michael Samarkos, Evangelos Cholongitas, First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Evangelos Cholongitas, MD, PhD, Associate Professor, First Department of Internal Medicine, Medical School of National & Kapodistrian University of Athens, Laiko General Hospital, Agiou Thoma 17, Athens 11527, Greece. cholongitas@yahoo.gr
Telephone: +30-6936-378903 Fax: +30-2310-992940
Received: May 28, 2018
Peer-review started: May 28, 2018
First decision: July 4, 2018
Revised: July 11, 2018
Accepted: July 21, 2018
Article in press: July 21, 2018
Published online: September 14, 2018

Cirrhosis is an increasing cause of morbidity and mortality. Recent studies are trying to clarify the role of microbiome in clinical exacerbation of patients with decompensated cirrhosis. Nowadays, it is accepted that patients with cirrhosis have altered salivary and enteric microbiome, characterized by the presence of dysbiosis. This altered microbiome along with small bowel bacterial overgrowth, through translocation across the gut, is associated with the development of decompensating complications. Studies have analyzed the correlation of certain bacterial families with the development of hepatic encephalopathy in cirrhotics. In general, stool and saliva dysbiosis with reduction of autochthonous bacteria in patients with cirrhosis incites changes in bacterial defenses and higher risk for bacterial infections, such as spontaneous bacterial peritonitis, and sepsis. Gut microbiome has even been associated with oncogenic pathways and under circumstances might promote the development of hepatocarcinogenesis. Lately, the existence of the oral-gut-liver axis has been related with the development of decompensating events. This link between the liver and the oral cavity could be via the gut through impaired intestinal permeability that allows direct translocation of bacteria from the oral cavity to the systemic circulation. Overall, the contribution of the microbiome to pathogenesis becomes more pronounced with progressive disease and therefore may represent an important therapeutic target in the management of cirrhosis.

Keywords: Microbiome, Dysbiosis, Oral-gut-liver axis, Hepatic encephalopathy, Decompensated cirrhosis, Liver carcinoma

Core tip: Human microbiome of the oral-gut-liver axis is implicated in the progression of hepatic diseases and the development of decompensated events. Its significance over diagnostic, prognostic and therapeutic possibilities drives a new era in the management of patients with cirrhosis.