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Gut : liver : brain axis: the microbial challenge in the hepatic encephalopathy

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Hepatic encephalopathy (HE) is a debilitating neuropsychiatric condition often associated with acute liver failure or cirrhosis. Advanced liver diseases are characterized by a leaky gut and systemic inflammation. There is strong evidence that the pathogenesis of HE is linked to a dysbiotic gut microbiota and to harmful microbial by-products, such as ammonia, indoles, oxindoles and endotoxins. Increased concentrations of these toxic metabolites together with the inability of the diseased liver to clear such products is thought to play an important patho-ethiological role. Current first line clinical treatments target microbiota dysbiosis by decreasing the counts of pathogenic bacteria, blood endotoxemia and ammonia levels. This review will focus on the role of the gut microbiota and its metabolism in HE and advanced cirrhosis. It will critically assess data from different clinical trials measuring the efficacy of the prebiotic lactulose, the probiotic VSL#3 and the antibiotic rifaximin in treating HE and advanced cirrhosis, through gut microbiota modulation. Additionally data from Randomised Controlled Trials using pre-, pro- and synbiotic will be also considered by reporting meta-analysis studies. The large amount of existing data showed that HE is a clear example of how an altered gut microbiota homeostasis can influence and impact on physiological functions outside the intestine, with implication for host health at the systems level. Nevertheless, a strong effort should be made to increase the information on gut microbiota ecology and its metabolic function in liver diseases and HE.

Graphical abstract: Gut : liver : brain axis: the microbial challenge in the hepatic encephalopathy

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Publication details

The article was received on 01 Oct 2017, accepted on 20 Feb 2018 and first published on 27 Feb 2018

Article type: Review Article
DOI: 10.1039/C7FO01528C
Citation: Food Funct., 2018, Advance Article
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    Gut : liver : brain axis: the microbial challenge in the hepatic encephalopathy

    A. Mancini, F. Campagna, P. Amodio and K. M. Tuohy, Food Funct., 2018, Advance Article , DOI: 10.1039/C7FO01528C

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