Gut-liver axis in liver cirrhosis: How to manage leaky gut and endotoxemia

Abstract

A “leaky gut” may be the cutting edge for the passage of toxins, antigens or bacteria into the body, and may play a pathogenic role in advanced liver cirrhosis and its complications. Plasma endotoxin levels have been admitted as a surrogate marker of bacterial translocation and close relations of endotoxemia to hyperdynamic circulation, portal hypertension, renal, cardiac, pulmonary and coagulation disturbances have been reported. Bacterial overgrowth, increased intestinal permeability, failure to inactivate endotoxin, activated innate immunity are all likely to play a role in the pathological states of bacterial translocation. Therapeutic approach by management of the gut-liver axis by antibiotics, probiotics, synbiotics, prebiotics and their combinations may improve the clinical course of cirrhotic patients. Special concern should be paid on anti-endotoxin treatment. Adequate management of the gut-liver axis may be effective for prevention of liver cirrhosis itself by inhibiting the progression of fibrosis.

Keywords: Gut-liver axis; Liver cirrhosis; Pathogenesis; Complications; Endotoxemia; Bacterial translocation; Leaky gut; Toll-like receptors; Selective intestinal decontamination; Probiotics

Core tip: A “leaky gut” may be the cutting edge for the passage of toxins, antigens or bacteria into the body, and may play a pathogenic role in advanced liver cirrhosis and its complications. More attention should be paid to the role of intestinal bacteria and bacterial products in the field of Hepatology. Here, I would like to overview the history of endotoxin assay in the blood, clinical significance of endotoxemia in liver cirrhosis and then shift to the topic of gut and liver in general. Understanding of the gut-liver axis, leaky gut and endotoxemia in cirrhosis may give us new ideas.