Portocaval shunts' role in gut microbiota and hepatic encephalopathy: The gut-to-brain pathway

Abstract

I read the study by Zhao et al with great interest. Although the study design was quite complicated, it was successful in raising awareness of science and relevant researchers. Thirty patients with liver cirrhosis and portal hypertension secondary to chronic hepatitis B were included in the study. They were treated for variceal bleeding and underwent trans-jugular intrahepatic portosystemic shunt to prevent the recurrence of variceal bleeding and to reduce portal pressure. The authors evaluated the effects of changes in gut microbiota (GM) on hepatic encephalopathy secondary to portocaval bypass. The GM is greatly affected by local and general factors, including herbal and medical drugs, a person's dietary characteristics (carnivorous, vegan, vegetarian), supplementary foods, drinking water sources, and living in a city center or town. Therefore, I congratulate Zhao et al for their concise and comprehensive study on a multifactorial subject.

Keywords: Chronic hepatitis B; Liver cirrhosis; Transjugular intrahepatic portosystemic shunt; Intestinal microbiota; Hepatic encephalopathy

Core Tip: The gut microbiota (GM) has evolved with the host and has become an integral part of the human body. The GM is highly dynamic and changes depending on the person's diseases, diet, habits, living area, water sources and many other factors. Changes in GM abundance can affect some basic immunological, metabolic, structural and neurological functions of the human body. Therefore, the GM has important effects on both the physical and mental health of an individual. In this beautiful study by Zhao et al examining GM changes after trans-jugular intrahepatic portosystemic shunt, the effect of the dynamic process in GM and its relationship with hepatic encephalopathy are beautifully described.