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Copyright ©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Dec 7, 2014; 20(45): 16795-16810
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16795
Table 1 Changes in intestinal microbiota and clinical consequence in cirrhosis
Ref.Implicated dysbiosisPotential biological functions
Cirrhosis vs healthy peopleStool samples, Bajaj et al[5]Overgrowth of (family):There is a reduction in autochthonous taxa that can be disruptive given that they produce short-chain fatty acids that reduce colonic inflammation and nourish colonocytes improving the intestinal barrier
Leuconostocaceae ↑
Enterobacteriaceae ↑↑↑
Fusobacteriaceae ↑
Alcaligenaceae ↑
Reduction of (family):
Clostridium Incertae sedis XIV ↓↓↓
Lachnospiraceae ↓
Ruminococcaceae ↓
Mucosal samples, Bajaj et al[5]Overgrowth of (family - genus):There was a significantly lower abundance of autochthonous genera (Clostridium Incertae Sedis XIV) and a higher abundance of potentially pathogenic ones (Enterococcus, Proteus, Clostridium) in cirrhotic patients compared with the mucosa of healthy controls
Clostridiaceae - Clostridium ↑
Enterococcaceae - Enterococcus ↑↑
Enterobacteriaceae - Proteus ↑
Reduction of (family - genus):
Clostridium Incertae sedis XIV ↓↓
Ruminococcaceae - Subdoligranulum ↓
Lachnospiraceae ↓
Cirrhotics with vs without infectionStool samples, Bajaj et al[18]Overgrowth of (family):There is an increase in abundance of pathogenic taxa, reduction in autochthonous taxa and higher endotoxemia compared to uninfected patients despite matching for MELD-score and medication confounders
Enterobacteriaceae ↑
Reduction of (family):
Clostridium Incertae sedis XIV ↓↓
Lachnospiraceae ↓↓
Ruminococcaeae ↓↓
Veillonellaceae ↓
Cirrhotics with vs without inflammationStool samples, Bajaj et al[18]Overgrowth of (family):This relative overgrowth of Enterobacteriaceae can result in endotoxemia due to increased production with worsening intestinal permeability, which has been associated with worsening disease severity and complications in cirrhosis. The lower abundance of butyrate producing genera (such as Roseburia and Ruminococcaceae) might represent a trophic injury to colonocytes
Bacteroidaceae
Enterobacteriaceae
Reduction of (family):
Clostridium Incertae sedis XIV
Lachnospiraceae
Ruminococcaeae
Roseburia
Cirrhotics with vs without hepatic encephalopathyMucosal samples, Bajaj et al[23]Overgrowth of (family - genus):Firmicutes such as members of genera Veillonella, Megasphaera, Bifidobacterium, and Enterococcus were higher in HE whereas Roseburia was more abundant in the no-HE group
Enterococcaceae - Enterococcus ↑
Veillonellaceae - Megasphaera ↑
Bifidobacteriaceae - Bifidobacterium ↑↑
Veillonellaceae - Veillonella ↑
Reduction of (family - genus):
Lachnospiraceae - Roseburia ↓↓
Higher MELD scoreStool samples, Bajaj et al[18]Overgrowth of (family):With the increase in cirrhosis severity, there was a significant increase in potentially pathogenic and decrease in autochthonous taxa
Staphylococcae
Enterococceae
Enterobacteriaceae
Reduction of (family):
Clostridium Incertae sedis XIV
Lachnospiraceae
Ruminococcaeae
Rikenellaceae
Cirrhotics with vs without decompensated diseaseStool samples, Bajaj et al[18]Overgrowth of (family):With the increase in cirrhosis severity, there was a significant increase in potentially pathogenic and decrease in autochthonous taxa
Enterobacteriaceae ↑
Alcaligenaceae ↑
Reduction of (family):
Clostridium Incertae sedis XIV ↓
Lachnospiraceae ↓
Ruminococcaceae ↓
Veillonellaceae ↓
Aetiology of cirrhosis
Alcoholic aetiology vs othersStool samples, Bajaj et al[18]Overgrowth of (family):Alcoholic cirrhotics had a significantly higher abundance of Enterobacteriaceae and Halomonadaceae, lower Lachnospiraceae, Ruminococcaceae, and Clostridialies XIV, despite statistically similar MELD score and BMI compared to those without alcoholic etiology
Enterobacteriaceae ↑
Halomonadaeace ↑
Reduction of (family):
Clostridiales Incertae sedis XIV ↓
Lachnospiraceae ↓
Ruminococcaceae ↓
NASH aetiology vs othersOvergrowth of (family):There is a higher abundance of Porphyromonadaceae, Bacterioidaceae, and lower Veillonellaceae in NASH patients than the non-NASH counterparts
Bacteroidaceae ↑
Porphyromonadaceae ↑
Reduction of (family):
Veillonellaceae ↓
Table 2 Effects of the intervention on gut microbiota composition and its clinical and/or biochemical consequences
Ref.Type of studyCategory of patientsTherapyClinical outcomeMicrobiota changing
Albillos et al[68]RCT102 Cirrhotics/ 30 controlsNorfloxacin 400 mg orally TD vs PlaceboNorfloxacin improved cardiac index in patients with elevated LBP, no improvement in portal pressure in the rest of patientsNA
Bass et al[100]RCT299 cirrhoticsRifaximin 550 mg twice daily (140 patients) vs placebo (159 patients)Rifaximin group maintained remission from hepatic encephalopathy more effectively than did placeboNA
Rayes et al[104]RCT66 cirrhotics underwent LTPediacoccus pentosaceus + Leuconostoc mesenteroides + Lactobacillus paracasei and L. plantarum vs PlaceboSignificant reduction of post-operative bacterial infections (3% vs 48% of controlls)NA
Lata et al[105]RCT39 cirrhoticsCirrhotics were randomly allocated to treatment with E. coli Nissle or placebo for 42 dIn 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]RCT94 cirrhotic patients with large oesophageal varices without history of variceal bleedingPatients were randomized to three treatment Groups: (1) propranolol plus placebo (2) propranolol Plus norfloxacin 400 mg BD (3) propranolol plus VSL#3, 900 billion/dGroup 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 1NA
Bajaj et al[107]RCT25 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 ratioTwelve 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 groupsNA
Bajaj et al[56]PS20 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 studyThere was a significant improvement in cognition test performance and a reduction of endotoxemia after rifaximinAfter 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 modelMice with induced NAFLDFor 8 wk, C57BL/ J6 mice had free access to solutions containing 30% glucose, fructose, sucrose, or water sweetened with artificial sweetener or plain waterThe group treated with polymixin B and Neomycin were protected against the fructose-induced NAFLD and had a lower level of endotoxinNA