Prevention and treatment of hepatic encephalopathy: Focusing on gut microbiota

doi:10.3748/wjg.v18.i46.6693

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Dec 14, 2012 (publication date) through Nov 4, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Dec 14, 2012; 18(46): 6693-6700
Published online Dec 14, 2012. doi: 10.3748/wjg.v18.i46.6693

Prevention and treatment of hepatic encephalopathy: Focusing on gut microbiota

Matteo Garcovich, Maria Assunta Zocco, Davide Roccarina, Francesca Romana Ponziani, Antonio Gasbarrini

Matteo Garcovich, Maria Assunta Zocco, Davide Roccarina, Francesca Romana Ponziani, Antonio Gasbarrini, Department of Internal Medicine, Catholic University of Sacred Heart, 00197 Rome, Italy

Author contributions: Garcovich M, Zocco MA and Gasbarrini A contributed to the article design, drafting and revision; Roccarina D and Ponziani FR contributed to the literature research, writing and revision, all authors approved the version to be published.

Correspondence to: Matteo Garcovich, MD, Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Largo A. Gemelli 8, 00197 Rome, Italy. matteogarcovich@yahoo.it

Telephone: +39-6-30156018 Fax: +39-6-30157249

Received: April 3, 2012
Revised: July 30, 2012
Accepted: August 4, 2012
Published online: December 14, 2012

Abstract

The gut flora plays an important role in the pathogenesis of the complications of cirrhosis. Hepatic encephalopathy (HE) represents a broad continuum of neuropsychological dysfunction in patients with acute or chronic liver disease and/or porto-systemic shunting of blood flow and it manifests with progressive deterioration of the superior neurological functions. The pathophysiology of this disease is complex, as it involves overproduction and reduced metabolism of various neurotoxins, particularly ammonia. Management of HE is diversified and requires several steps: elimination of precipitating factors, removal of toxins, proper nutritional support, modulation of resident fecal flora and downregulation of systemic and gut-derived inflammation. This review will provide an overview of gut barrier function and the influence of gut-derived factors on HE, focusing on the role of gut microbiota in the pathogenesis of HE and the recent literature findings on its therapeutic manipulation.

Keywords: Hepatic encephalopathy; Gut microbiota; Cirrhosis; Non-absorbable disaccharides; Rifaximin