Published online Aug 21, 2024. doi: 10.3748/wjg.v30.i31.3668
Revised: July 11, 2024
Accepted: August 2, 2024
Published online: August 21, 2024
Processing time: 154 Days and 21.2 Hours
Gut microbiota (GM) affects the progression and response to treatment in liver diseases. The GM composition is diverse and associated with different etiologies of liver diseases. Notably, alterations in GM alterations are observed in patients with portal hypertension (PH) secondary to cirrhosis, with hepatitis B virus (HBV) infection being a major cause of cirrhosis in China. Thus, understanding the role of GM alterations in patients with HBV infection-related PH is essential.
To evaluate GM alterations in patients with HBV-related PH after transjugular intrahepatic portosystemic shunt (TIPS) placement.
This was a prospective, observational clinical study. There were 30 patients (with a 100% technical success rate) recruited in the present study. Patients with esophagogastric variceal bleeding due to HBV infection-associated PH who underwent TIPS were enrolled. Stool samples were obtained before and one month after TIPS treatment, and GM was analyzed using 16S ribosomal RNA amplicon sequencing.
One month after TIPS placement, 8 patients developed hepatic encephalopathy (HE) and were assigned to the HE group; the other 22 patients were assigned to the non-HE group. There was no substantial disparity in the abundance of GM at the phylum level between the two groups, regardless of TIPS treatment (all, P > 0.05). However, following TIPS placement, the following results were observed: (1) The abundance of Haemophilus and Eggerthella increased, whereas that of Anaerostipes, Dialister, Butyricicoccus, and Oscillospira declined in the HE group; (2) The richness of Eggerthella, Streptococcus, and Bilophila increased, whereas that of Roseburia and Ruminococcus decreased in the non-HE group; and (3) Members from the pathogenic genus Morganella appeared in the HE group but not in the non-HE group.
Intestinal microbiota-related synergism may predict the risk of HE following TIPS placement in patients with HBV-related PH. Prophylactic microbiome therapies may be useful for preventing and treating HE after TIPS placement.
Core Tip: Gut microbiota (GM) alterations have been demonstrated in patients with portal hypertension, influencing hepatic encephalopathy (HE) development. The present study analyzes the changes in GM composition in Chinese patients with hepatitis B virus related portal hypertension before and after transjugular intrahepatic portosystemic shunt (TIPS). The results revealed that patients without HE exhibited higher GM-related synergism than those with HE, regardless of TIPS placement. Thus, the synergism of intestinal microbiota may serve as a useful indicator to predict the risk of HE after TIPS placement.