Background: Understanding of the gut-liver axis is important for the up-to-date management of liver cirrhosis, and changes of intestinal functions form the core o

/pdf/changes-of-intestinal-functions-in-liver-cirrhosis-3jpifzc6ch.pdf

Changes of Intestinal Functions in Liver Cirrhosis

https://www.journal-of-hepatology.eu/article/S0168-8278(13)00602-8/pdf

Pathological bacterial translocation in liver cirrhosis.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20632

Bacterial translocation (BT) in cirrhosis.

The intestine constitutes the largest interface between a person and his or her environment, and an intact intestinal barrier is thus essential in maintaining health and preventing tissue injury and several diseases. The intestinal barrier has various immunological and non-immunological components. The epithelial barrier is one of the most important non-immunological components. Hyperpermeability of this barrier is believed to contribute to the pathogenesis of several gastrointestinal disorders including inflammatory bowel disease, celiac disease and food allergy. Hence, assessing barrier integrity is of the utmost importance. One of the more quantitative gauges for this assessment is transepithelial permeability of various molecular probes, among which sugars are commonly used. Measures of intestinal permeability might also be useful as markers for assessment of prognosis and follow up in various gastrointestinal disorders. The present article is a review of the normal and abnormal functioning of the intestinal barrier, the diseases that can result from loss of barrier integrity, and some promising agents and strategies for restoring barrier normality and integrity.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1440-1746.2003.03032.x

Intestinal barrier: an interface between health and disease.

Much of the immune system is situated in the gastrointestinal tract.1–4 Disruption of gut barrier function and intestinal microbial imbalance can result in systemic inflammation and ultimately induce septic complications after surgery.5–7 Despite improvements in surgical techniques and refinements in perioperative care, the high incidence of postoperative infectious complications in patients undergoing hepatobiliary resection for biliary cancer remains a major problem.8–12 Enteral feeding is one effective treatment among several strategies aiming to minimize postoperative septic complications concerning bacterial translocation.13–15 A recently proposed refinement of enteral feeding suggests dietary supplements including probiotics and prebiotics as having have a potential to prevent bacterial translocation.16–19

Probiotics, viable bacteria that benefit the host by improving intestinal microbial balance, now are used widely in food supplements.20 Prebiotics are nondigestable food constituents that selectively alter growth or activity of one or a limited number of bacterial species in the colon in a manner that potentially improves the health of the host.20–22 Used in combination, probiotics and prebiotics are called synbiotics.22 While synbiotic combinations are considered to have beneficial effects on human health, their clinical value in surgical patients remains unclear given a paucity of applicable clinical studies.23–25 We recently assessed clinical usefulness of synbiotics in biliary cancer patients who underwent hepatobiliary resection, finding that postoperative synbiotic administration reduced infectious complications after hepatectomy, mainly by correcting an intestinal microbial imbalance.26 Based on this observation, we hypothesized that additional preoperative administration of synbiotics should reduce infectious complications still more effectively.

The present prospective randomized study was designed to investigate the effect of preand postoperative administration of synbiotics on intestinal permeability, integrity, immune responses, systemic inflammatory responses, and microflora, as well as surgical outcome, in a clinical setting.

Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial.

Intestinal mucosal barrier function in obstructive jaundice was assessed in an animal model and in patients. The effect of internal biliary drainage in patients was also examined. Bile duct ligation for 1 week in the rat resulted in significant bacterial translocation (in seven of 12 animals following ligation versus none of the shamoperated controls, P < 0.01). Intestinal permeability, measured by the urinary recovery of orally administered polyethylene glycol, was also significantly increased (+66.2 per cent for ligation versus -11.6 per cent for sham, P < 0.01). A prospective study was performed on 33 patients with obstructive jaundice undergoing internal biliary drainage, and results were compared with those in six non-jaundiced patients undergoing laparotomy or endoscopic retrograde cholangiopancreatography and in 11 health volunteers. The lactulose: mannitol ratio was used as an intestinal permeability index. Mean(s.e.m.) intestinal permeability assessed before operation was significantly increased in jaundiced patients compared with control patients (0.050(0.010) versus 0.016(0.003), P < 0.005). The mean(s.e.m.) lactulose: mannitol ratio in the healthy volunteers was 0.020(0.003), which was similar to that in control patients. In the jaundiced group of patients the intestinal permeability index fell to within normal levels after 28 days of internal biliary drainage (0.050 before operation versus 0.021 at 28 days, P < 0.02). These data indicate that intestinal barrier function is impaired in obstructive jaundice and that this impairment is reversed by return of bile to the gastrointestinal tract.

Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage.

Bacterial translocation from the gut is implicated in the pathophysiology of complications associated with obstructive jaundice. Absence of intraluminal bile salts and their antiendotoxic effects may result in overgrowth of bacteria, promoting bacterial translocation. The large bowel is the largest source of gram negative bacteria but the small bowel is more permeable. This study investigated the effect of obstructive jaundice on bacterial translocation and on the indigenous luminal microflora at 3 sites in the gastrointestinal tract. Significant bacterial translocation was demonstrated following 7 d of bile duct ligation compared with control or sham operated groups. A qualitative disturbance of the caecal indigenous microflora was demonstrated in jaundiced rats. There was no 'site-to-site' variation in the indigenous microflora at the 3 intestinal sites studied. We conclude that experimental obstructive jaundice for 1 wk promotes bacterial translocation without significant quantitative disturbance of the intestinal microflora in the small intestinal or caecum.

Bacterial translocation and gut microflora in obstructive jaundice.

The importance of overcoming the challenges in delivering the Proper Understanding of Recurrent Stress Urinary Incontinence Treatment (PURSUIT) study

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Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage.

Bacterial translocation and gut microflora in obstructive jaundice.

The importance of overcoming the challenges in delivering the Proper Understanding of Recurrent Stress Urinary Incontinence Treatment (PURSUIT) study