Targeting the Gut Microbiota in CLD

As liver disease progresses, gut microbiota play a larger role in its pathogenesis. Gut microbiota therefore have become an important therapeutic target in the management of cirrhosis.2

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Lactulose and antibiotics are used as initial treatment for overt HE as well as for prevention of recurrent overt HE episodes.7

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Probiotics and synbiotics have been assessed for the management of minimal HE2,3,7; however, there is no established standard of care to guide their use at this time.7

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Fecal microbiota transplantation is a novel method being explored in the management of recurrent overt HE, but its use has not yet been validated.2,3

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Future therapies for cirrhosis may focus more on the gut-liver axis, which includes gut microbiota.3

Future Directions of Microbiota Research in Liver Disease3
Diagnosis of advanced fibrosis
Functional characterization of microbiota
Nonbacterial microbiota analysis
Sources of microbially mediated inflammation
Diet and cultural habits on microbiota composition
Prognostication using microbial composition and functionality
Precision microbial therapies
CLD = chronic liver disease
HE = hepatic encephalopathy


  1. Acharya C, Bajaj JS. Gut microbiota and complications of liver disease. Gastroenterol Clin North Am. 2017;46(1):155-169.
  2. Oikonomou T, Papatheodoridis GV, Samarkos M, Goulis I, Cholongitas E. Clinical impact of microbiome in patients with decompensated cirrhosis. World J Gastroenterol. 2018;24(34):3813-3820.
  3. Acharya C, Bajaj JS. Altered microbiome in patients with cirrhosis and complications. Clin Gastroenterol Hepatol. 2019;17:307-321.
  4. Bajaj JS, Heuman DM, Hylemon PB, et al. Altered profile of human gut microbiome is associated with cirrhosis and its complications. J Hepatol. 2014;60(5):940-947.
  5. Minemura M, Shimizu Y. Gut microbiota and liver diseases. World J Gastroenterol. 2015;21(6):1691-1702.
  6. Boursier J, Mueller O, Barret M, et al. The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology. 2016;63(3):764-775.
  7. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-735.

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