Alcohol or Gut Microbiota: Who Is the Guilty?

Int J Mol Sci. 2019 Sep 14;20(18):4568. doi: 10.3390/ijms20184568.


Alcoholic liver disease (ALD), a disorder caused by excessive alcohol intake represents a global health care burden. ALD encompasses a broad spectrum of hepatic injuries including asymptomatic steatosis, alcoholic steatohepatitis (ASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The susceptibility of alcoholic patients to develop ALD is highly variable and its progression to more advanced stages is strongly influenced by several hits (i.e., amount and duration of alcohol abuse). Among them, the intestinal microbiota and its metabolites have been recently identified as paramount in ALD pathophysiology. Ethanol abuse triggers qualitative and quantitative modifications in intestinal flora taxonomic composition, mucosal inflammation, and intestinal barrier derangement. Intestinal hypermeability results in the translocation of viable pathogenic bacteria, Gram-negative microbial products, and pro-inflammatory luminal metabolites into the bloodstream, further corroborating the alcohol-induced liver damage. Thus, the premise of this review is to discuss the beneficial effect of gut microbiota modulation as a novel therapeutic approach in ALD management.

Keywords: alcoholic liver disease; fecal microbiota transplantation; gut microbiota; gut-liver axis; intestinal permeability; leaky gut; target therapy; tight junctions.

Publication types

  • Review

MeSH terms

  • Alcoholism / genetics
  • Alcoholism / immunology
  • Alcoholism / microbiology*
  • Alcoholism / physiopathology
  • Animals
  • Anti-Bacterial Agents / adverse effects
  • Bile Acids and Salts / metabolism
  • Diet
  • Dietary Supplements / microbiology
  • Dysbiosis / immunology
  • Dysbiosis / metabolism
  • Fecal Microbiota Transplantation
  • Gastrointestinal Microbiome / physiology*
  • Hepatocytes / metabolism
  • Humans
  • Intestines / microbiology
  • Liver / metabolism
  • Liver / physiopathology
  • Liver Diseases, Alcoholic / immunology
  • Liver Diseases, Alcoholic / metabolism
  • Liver Diseases, Alcoholic / microbiology*
  • Liver Diseases, Alcoholic / physiopathology


  • Anti-Bacterial Agents
  • Bile Acids and Salts