Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 18, 2015; 7(17): 2058-2068
Published online Aug 18, 2015. doi: 10.4254/wjh.v7.i17.2058
Intestinal barrier dysfunction in cirrhosis: Current concepts in pathophysiology and clinical implications
Georgios I Tsiaoussis, Stelios F Assimakopoulos, Athanassios C Tsamandas, Christos K Triantos, Konstantinos C Thomopoulos
Georgios I Tsiaoussis, Christos K Triantos, Konstantinos C Thomopoulos, Department of Gastroenterology and Hepatology, University Hospital of Patras, CP 26504 Patras, Greece
Stelios F Assimakopoulos, Department of Internal Medicine, University Hospital of Patras, CP 26504 Patras, Greece
Athanassios C Tsamandas, Department of Pathology, University Hospital of Patras, CP 26504 Patras, Greece
Author contributions: Tsiaoussis GI and Thomopoulos KC wrote the paper, conceptualized and designated the work; Assimakopoulos SF, Tsamandas AC and Triantos CK critically revised the paper.
Conflict-of-interest statement: None of the authors have any conflict of interest related to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georgios I Tsiaoussis, MD, Department of Gastroenterology and Hepatology, University Hospital of Patras, Rio Patras, CP 26504 Patras, Greece. tsiaoussisgeorgios@yahoo.com
Telephone: +30-2610-992861 Fax: +30-2610-992861
Received: February 25, 2015
Peer-review started: February 26, 2015
First decision: May 14, 2015
Revised: June 22, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 18, 2015
Abstract

The intestinal lumen is a host place for a wide range of microbiota and sets a unique interplay between local immune system, inflammatory cells and intestinal epithelium, forming a physical barrier against microbial invaders and toxins. Bacterial translocation is the migration of viable or nonviable microorganisms or their pathogen-associated molecular patterns, such as lipopolysaccharide, from the gut lumen to the mesenteric lymph nodes, systemic circulation and other normally sterile extraintestinal sites. A series of studies have shown that translocation of bacteria and their products across the intestinal barrier is a commonplace in patients with liver disease. The deterioration of intestinal barrier integrity and the consulting increased intestinal permeability in cirrhotic patients play a pivotal pathophysiological role in the development of severe complications as high rate of infections, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, variceal bleeding, progression of liver injury and hepatocellular carcinoma. Nevertheless, the exact cellular and molecular mechanisms implicated in the phenomenon of microbial translocation in liver cirrhosis have not been fully elucidated yet.

Keywords: Cirrhosis, Intestinal barrier, Tight junction, Bacterial translocation, Intestinal bacterial overgrowth

Core tip: Intestinal barrier function is impaired in patients with cirrhosis and this derangement seems to be associated with liver disease severity. This phenomenon is multifactorial and the exact pathophysiological mechanisms which are implicated in this deterioration have not been fully elucidated yet. The disruption of intestinal barrier integrity and the subsequent increased intestinal permeability in cirrhotic patients promote bacterial translocation and play a major role in the development of severe clinical complications affecting natural history of liver disease and patients’ survival.