Intestinal permeability in a patient with liver cirrhosis

Abstract

Jonathan Manuel Aguirre Valadez,1 Liliana Rivera-Espinosa,2 Osvely Méndez-Guerrero,1 Juan Luis Chávez-Pacheco,2 Ignacio García Juárez,1 Aldo Torre1 1Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición”Salvador Zubirán, 2Pharmacology Laboratory, Instituto Nacional de Pediatría, Mexico City, Mexico Abstract: Liver cirrhosis is a worldwide public health problem, and patients with this disease are at high risk of developing complications, bacterial translocation from the intestinal lumen to the mesenteric nodes, and systemic circulation, resulting in the development of severe complications related to high mortality rate. The intestinal barrier is a structure with a physical and biochemical activity to maintain balance between the external environment, including bacteria and their products, and the internal environment. Patients with liver cirrhosis develop a series of alterations in different components of the intestinal barrier directly associated with the severity of liver disease that finally increased intestinal permeability. A “leaky gut” is an effect produced by damaged intestinal barrier; alterations in the function of tight junction proteins are related to bacterial translocation and their products. Instead, increasing serum proinflammatory cytokines and hemodynamics modification, which results in the appearance of complications of liver cirrhosis such as hepatic encephalopathy, variceal hemorrhage, bacterial spontaneous peritonitis, and hepatorenal syndrome. The intestinal microbiota plays a fundamental role in maintaining the proper function of the intestinal barrier; bacterial overgrowth and dysbiosis are two phenomena often present in people with liver cirrhosis favoring bacterial translocation. Increased intestinal permeability has an important role in the genesis of these complications, and treating it could be the base for prevention and partial treatment of these complications. Keywords: liver cirrhosis, hepatic encephalopathy, spontaneous bacterial peritonitis, variceal hemorrhage, bacterial translocation, intestinal permeability

Keywords

• intestinal permeability
• bacterial translocation
• liver cirrhosis