Intestinal permeability in the pathogenesis of liver damage: From non-alcoholic fatty liver disease to liver transplantation.

Publisher: Baishideng Publishing Group Country of Publication: United States NLM ID: 100883448 Publication Model: Print Cited Medium: Internet ISSN: 2219-2840 (Electronic) Linking ISSN: 10079327 NLM ISO Abbreviation: World J Gastroenterol Subsets: MEDLINE

Publication: 2014- : Pleasanton, CA : Baishideng Publishing Group
Original Publication: Beijing : WJG Press, c1998-

Liver Transplantation*; Hypertension, Portal/*etiology ; Intestinal Mucosa/*metabolism ; Liver Cirrhosis/*etiology ; Non-alcoholic Fatty Liver Disease/*etiology; Bacterial Translocation ; Disease Progression ; Dysbiosis/complications ; Dysbiosis/pathology ; Humans ; Hypertension, Portal/pathology ; Hypertension, Portal/surgery ; Intestinal Mucosa/pathology ; Liver/metabolism ; Liver/pathology ; Liver Cirrhosis/pathology ; Liver Cirrhosis/surgery ; Non-alcoholic Fatty Liver Disease/pathology ; Permeability ; Treatment Outcome

The intimate connection and the strict mutual cooperation between the gut and the liver realizes a functional entity called gut-liver axis. The integrity of intestinal barrier is crucial for the maintenance of liver homeostasis. In this mutual relationship, the liver acts as a second firewall towards potentially harmful substances translocated from the gut, and is, in turn, is implicated in the regulation of the barrier. Increasing evidence has highlighted the relevance of increased intestinal permeability and consequent bacterial translocation in the development of liver damage. In particular, in patients with non-alcoholic fatty liver disease recent hypotheses are considering intestinal permeability impairment, diet and gut dysbiosis as the primary pathogenic trigger. In advanced liver disease, intestinal permeability is enhanced by portal hypertension. The clinical consequence is an increased bacterial translocation that further worsens liver damage. Furthermore, this pathogenic mechanism is implicated in most of liver cirrhosis complications, such as spontaneous bacterial peritonitis, hepatorenal syndrome, portal vein thrombosis, hepatic encephalopathy, and hepatocellular carcinoma. After liver transplantation, the decrease in portal pressure should determine beneficial effects on the gut-liver axis, although are incompletely understood data on the modifications of the intestinal permeability and gut microbiota composition are still lacking. How the modulation of the intestinal permeability could prevent the initiation and progression of liver disease is still an uncovered area, which deserves further attention.
Competing Interests: Conflict-of-interest statement: Nothing to declare.

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Keywords: Bacterial translocation; Cirrhosis; Gut microbiota; Gut-liver axis; Liver disease; Mediterranean diet; Personalized medicine

Date Created: 20190924 Date Completed: 20200217 Latest Revision: 20200225

20240628

PMC6737313

10.3748/wjg.v25.i33.4814

31543676