Microbiota and the gut-liver axis: Bacterial translocation, inflammation and infection in cirrhosis

Table 2 Effects of the intervention on gut microbiota composition and its clinical and/or biochemical consequences

Ref.	Type of study	Category of patients	Therapy	Clinical outcome	Microbiota changing
Albillos et al[68]	RCT	102 Cirrhotics/ 30 controls	Norfloxacin 400 mg orally TD vs Placebo	Norfloxacin improved cardiac index in patients with elevated LBP, no improvement in portal pressure in the rest of patients	NA
Bass et al[100]	RCT	299 cirrhotics	Rifaximin 550 mg twice daily (140 patients) vs placebo (159 patients)	Rifaximin group maintained remission from hepatic encephalopathy more effectively than did placebo	NA
Rayes et al[104]	RCT	66 cirrhotics underwent LT	Pediacoccus pentosaceus + Leuconostoc mesenteroides + Lactobacillus paracasei and L. plantarum vs Placebo	Significant reduction of post-operative bacterial infections (3% vs 48% of controlls)	NA
Lata et al[105]	RCT	39 cirrhotics	Cirrhotics were randomly allocated to treatment with E. coli Nissle or placebo for 42 d	In probiotic group , the authors found a trend of significant lowering of the endotoxemia (P = 0.07) and improvement of Child-Pugh score (P = 0.06)	Restoration of normal colonic colonization in pts treated with E. coli Nissle
Gupta et al[106]	RCT	94 cirrhotic patients with large oesophageal varices without history of variceal bleeding	Patients were randomized to three treatment Groups: (1) propranolol plus placebo (2) propranolol Plus norfloxacin 400 mg BD (3) propranolol plus VSL#3, 900 billion/d	Group 2 and 3 showed a greater reduction in HVPG than Group 1. In addition, in Group 2 and 3 the TNF-a levels were significantly lower than Group 1	NA
Bajaj et al[107]	RCT	25 nonalcoholic MHE cirrhotics (defined by a standard psychometric battery)	Cirrhotics were randomized to Receive yogurt contained Lactobacillus bulgaricus and Streptococcus Thermophilus or no treatment for 60 d in a 2:1 ratio	Twelve of 17 yogurt patients reversed MHE (71% on intention-to-treat and 86% on per-protocol analysis) compared to 0% in the no-treatment group (P = 0.0030) Levels of citokyne were similar between groups	NA
Bajaj et al[56]	PS	20 nonalcoholic MHE cirrhotics (defined by a standard psychometric battery)	Patients received rifaximin 550 mg BID for 8 wk and the psychometric tests, stool analysis and blood test were repeated at the end of the study	There was a significant improvement in cognition test performance and a reduction of endotoxemia after rifaximin	After rifaximin there was a significant reduction in the abundance of faecal Veillonellaceae (P = 0.025) and increase in the abundance of Eubacteriaceae (P = 0.042)
Bergheim et al[101]	Animal model	Mice with induced NAFLD	For 8 wk, C57BL/ J6 mice had free access to solutions containing 30% glucose, fructose, sucrose, or water sweetened with artificial sweetener or plain water	The group treated with polymixin B and Neomycin were protected against the fructose-induced NAFLD and had a lower level of endotoxin	NA

RCT: Randomized controlled study; PS: Pilot study; LT: Liver translanted; NA: Not applicable (the study did not provide microbiota characterization); BD: Bis in die; HVPG: Hepatic venus pressure gradient; NAFLD: Non-alcoholic fatty liver disease.