[Intestinal permeability and cirrhosis]

Area of Science:

• Gastroenterology
• Hepatology
• Infectious Diseases

Background:

• Cirrhosis patients have an elevated risk of infections due to bacterial translocation.
• Bacterial translocation is influenced by bacterial overgrowth, immune suppression, and compromised intestinal permeability.
• Alcohol toxicity and portal hypertensive enteropathy can disrupt intestinal barrier function in cirrhosis.

Purpose of the Study:

• To review the assessment of intestinal permeability in cirrhotic patients.
• To explore the relationship between intestinal permeability and infection risk.
• To evaluate the potential for intestinal permeability as a predictive factor for preventive antibiotherapy.

Main Methods:

• Systematic review of studies assessing intestinal permeability in cirrhosis.
• Analysis of factors contributing to bacterial translocation.
• Evaluation of criteria for spontaneous bacterial peritonitis recurrence.
• Assessment of current recommendations for antibiotic prophylaxis.

Main Results:

• Four studies using the lactulose-mannitol test indicated increased intestinal permeability in cirrhotic patients.
• Contradictory results in existing literature may stem from methodological variations.
• Predictive factors for spontaneous bacterial peritonitis recurrence include low ascites protein, high bilirubin, and thrombocytopenia.

Conclusions:

• Increased intestinal permeability is a significant factor in cirrhotic patients, potentially indicating infection risk.
• Further research with standardized methods is needed to confirm intestinal permeability as a reliable predictor for preventive antibiotherapy.
• Current recommendations for antibiotic prophylaxis are limited by concerns over antibiotic resistance and lack of demonstrated survival benefit.