Intestinal decontamination improves liver haemodynamics in patients with alcohol‐related decompensated cirrhosis
Open accessAbstract
Summary: Background Endotoxaemia is commonly seen in cirrhotic patients with ascites and this may be associated with increased portal pressure. Aim To investigate the effect of intestinal decontamination on liver haemodynamics in alcohol‐related cirrhotic patients with ascites. Methods We included 30 patients. At day 0, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed. Patients received rifaximin (1200 mg/day) for 28 days. At day 29, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed again. Results Median (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45(0–3.1) vs. 0.7(0–2.7), P < 0.0001] and splanchnic circulation [1.8(0–3.4) vs. 0.8(0–2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137). HVPG measurement was possible in 28 patients. Median (range) HVPG values were 18 mmHg (12.7–26.3) on day 0 vs. 14.7 mmHg (7–20) on day 29 (P < 0.0001). HVPG decreased after rifaximin in 23, remained stable in two and increased in three patients. Conclusion Hepatic venous pressure gradient values decreased significantly after intestinal decontamination with rifaximin in patients with alcohol‐related decompensated cirrhosis and this might have been achieved through significant reduction of plasma endotoxin levels.
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Rifaximin appears to reduce spontaneous bacterial peritonitis and may improve portal hypertension, suggesting it effectively targets the gut-liver axis in advanced liver disease.
“Moreover, rifaximin appears to reduce the development of spontaneous bacterial peritonitis and may improve portal hypertension, suggesting that it effectively targets the gut–liver axis in advanced liver disease93,114,115.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [114]
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- Authors
- VLACHOGIANNAKOS, J., SAVERIADIS, A. S., VIAZIS, N., THEODOROPOULOS, I., FOUDOULIS, K., MANOLAKOPOULOS, S., RAPTIS, S., & KARAMANOLIS, D. G.
- Affiliations
- Evangelismos Hospital (GR)
- National and Kapodistrian University of Athens (GR)
- University General Hospital Attikon (GR)
- Corresponding author
- VLACHOGIANNAKOS, J.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2009-04
- Volume
- 29
- Issue
- 9
- Pages
- 992-999
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W1990611190
- Cited by
- 163
- References
- 29
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 12 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 7 · 2019: 10 · 2018: 10 · 2017: 13 · 2016: 11 · 2015: 19 · 2014: 17 · 2013: 6 · 2012: 11
- FWCI
- 6.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Keywords
- intestinal decontamination, rifaximin, endotoxemia, endotoxin, hepatic venous pressure gradient, portal hypertension, alcoholic cirrhosis, decompensated cirrhosis, ascites, splanchnic circulation
- MeSH terms
- Rifaximin, Adult, Aged, Aged, 80 and over, Anti-Infective Agents, Ascites, Endotoxins, Female, Humans, Liver Circulation, Liver Cirrhosis, Male, Middle Aged, Rifamycins, Venous Pressure, Treatment Outcome, Alcohol-Related Disorders
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