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

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

Conflict of interest statement

Conflict-of-interest statement: Maslennikov R reports grants by Biocodex Microbiota Foundation (National Research Grant Russia 2019) outside the submitted work.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Links of the gut-liver axis in cirrhosis. SIBO: Small intestinal bacterial overgrowth.

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