Clinical and pathophysiological consequences of alterations in the microbiome in cirrhosis

Am J Gastroenterol. 2015 Oct;110(10):1399-410; quiz 1411. doi: 10.1038/ajg.2015.313. Epub 2015 Sep 29.


Cirrhosis is a major cause of mortality worldwide. Exponential rises in prevalence have been observed secondary to increases in obesity and alcohol consumption. Multiple lines of evidence implicate gut-derived bacteria and bacterial ligands as a central driver of pathogenesis. Recent developments in culture-independent techniques have facilitated a more accurate description of microbiome composition in cirrhosis and led to the description of measures of dysbiosis shown to be associated with disease. More importantly, metagenomic studies are adding to an understanding of the functional contribution of the microbiota and may prove to be a more clinically relevant biomarker than phylogenetic studies. Much like other dysbiotic states such as inflammatory bowel disease, the microbiota in cirrhosis is characterized by a low microbial and genetic diversity. Therapeutic strategies to diminish this process are currently limited to selective intestinal decontamination with antibiotics. This review summarizes the available data and develops a framework for the use of current and future treatment strategies to diminish the consequences of dysbiosis in cirrhosis. Interventional strategies to bind bacterial products in the gut lumen and blood, and modulate the magnitude of host sensing mechanisms remain an unmet clinical need. A greater understanding of the host-microbiota interaction in cirrhosis is of key importance to inform future interventional strategies to diminish the currently escalating burden of the disease.

Publication types

  • Review

MeSH terms

  • Biodiversity
  • Dysbiosis / etiology
  • Dysbiosis / microbiology*
  • Dysbiosis / physiopathology
  • Gastrointestinal Microbiome / genetics
  • Gastrointestinal Microbiome / physiology*
  • Genetic Variation
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / microbiology*
  • Liver Cirrhosis / physiopathology
  • Metagenomics
  • Phylogeny