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World J Clin Cases. Nov 6, 2021; 9(31): 9320-9332
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9320
Gut-liver axis in cirrhosis: Are hemodynamic changes a missing link?
Roman Maslennikov, Vladimir Ivashkin, Irina Efremova, Elena Poluektova, Elena Shirokova
Roman Maslennikov, Vladimir Ivashkin, Irina Efremova, Elena Poluektova, Elena Shirokova, Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia
Roman Maslennikov, Elena Poluektova, The Interregional Public Organization "Scientific Community for the Promotion of the Clinical Study of the Human Microbiome", Moscow 119435, Russia
Roman Maslennikov, Department of Internal Medicine, Consultative and Diagnostic Center of the Moscow City Health Department, Moscow 107564, Russia
Author contributions: This study was conceived by Ivashkin V and Maslennikov R; each author wrote specific sections of the manuscript; all authors took part in editing the final manuscript and approved it.
Conflict-of-interest statement: Maslennikov R reports grants by Biocodex Microbiota Foundation (National Research Grant Russia 2019) outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Roman Maslennikov, MD, PhD, Professor, Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Pogodinskaya street 1, Moscow 119435, Russia. mmmm00@yandex.ru
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: June 3, 2021
Revised: June 3, 2021
Accepted: September 7, 2021
Article in press: September 7, 2021
Published online: November 6, 2021
Processing time: 214 Days and 4.7 Hours
Abstract

Recent evidence suggests that the condition of the gut and its microbiota greatly influence the course of liver disease, especially cirrhosis. This introduces the concept of the gut–liver axis, which can be imagined as a chain connected by several links. Gut dysbiosis, small intestinal bacterial overgrowth, and intestinal barrier alteration lead to bacterial translocation, resulting in systemic inflammation. Systemic inflammation further causes vasodilation, arterial hypotension, and hyperdynamic circulation, leading to the aggravation of portal hypertension, which contributes to the development of complications of cirrhosis, resulting in a poorer prognosis. The majority of the data underlying this model were obtained initially from animal experiments, and most of these correlations were further reproduced in studies including patients with cirrhosis. However, despite the published data on the relationship of the disorders of the gut microbiota with the complications of cirrhosis and the proposed pathogenetic role of hemodynamic disorders in their development, the direct relations between gut dysbiosis and hemodynamic changes in this disease are poorly studied. They remain a missing link in the gut–liver axis and a challenge for future research.

Keywords: Gut microbiota; Gut dysbiosis; Small intestinal bacterial overgrowth; Intestinal barrier; Bacterial translocation; Vasodilation; Hyperdynamic circulation; Gut microbiome; Cardiac output; Systemic vascular resistance

Core Tip: Recent evidence suggests that the condition of the gut and its microbiota greatly influence the course of liver disease, especially cirrhosis. This introduces the concept of the gut–liver axis, which can be imagined as a chain connected by several links. However, despite the published data on the relationship of the disorders of the gut microbiota with the complications of cirrhosis and the proposed pathogenetic role of hemodynamic disorders in their development, the direct relations between gut dysbiosis and hemodynamic changes in this disease are poorly studied. They remain a missing link in the gut–liver axis and a challenge for future research.