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Intestinal permeability and bacterial translocation in patients with liver disease, focusing on alcoholic aetiology: methods of assessment and therapeutic intervention

Skinner, Charlotte, Thompson, Alex J., Thursz, Mark R., Marchesi, Julian R. and Vergis, Nikhil 2020. Intestinal permeability and bacterial translocation in patients with liver disease, focusing on alcoholic aetiology: methods of assessment and therapeutic intervention. Therapeutic Advances in Gastroenterology 13 , pp. 1-16. 10.1177/1756284820942616

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Abstract

Liver disease is a significant burden on global healthcare with approximately 2 million attributable deaths worldwide per year.1 Over 75 million people globally have been diagnosed with alcoholuse disorder, which puts them at risk of alcoholrelated liver disease (ArLD). Studies have shown that only around a third of those consuming harmful amounts of alcohol will develop significant fibrosis, and 1 in 10 will develop cirrhosis.2,3 The pathogenesis of ArLD is multifactorial and is influenced by individual metabolic, genetic and comorbidity variables as well as environmental factors4 One of these causative mechanisms may be the increased passage of bacteria or bacterial products into the systemic circulation – a process known as bacterial translocation (BT) – due to increased permeability of the intestinal barrier.5 An increase in bacterial products entering the liver via the portal circulation with an increase in pro-inflammatory cytokine release from Kupffer cell stimulation leads to further hepatocellular injury. Assessment of intestinal permeability (IP) can be performed by direct functional assessment of the intestinal barrier using non-absorbable probes, usually oligosaccharides. Alternatively, surrogate markers of barrier function can be measured including systemic biomarkers or bacterial products. Identification of this pathway in the development of ArLD opens up the possibility of therapeutic intervention. In this article, we review the current knowledge around BT and IP in ArLD, including methods of assessment and therapeutic intervention that are in clinical use or under development. The therapeutic strategies discussed include manipulation of the gut microbiome through antibiotic decontamination, use of probiotics and faecal microbiota transplantation (FMT).

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Biosciences
Additional Information: https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us-sagepub-com.abc.cardiff.ac.uk/en-us/nam/open-access-at-sage).
Publisher: SAGE
ISSN: 1756-283X
Date of First Compliant Deposit: 30 October 2020
Date of Acceptance: 25 June 2020
Last Modified: 02 Nov 2020 10:00
URI: http://orca.cf.ac.uk/id/eprint/136062

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