Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

Abstract

Acute-on-chronic liver failure (ACLF) is considered a distinct syndrome in patients with liver disease, with systemic inflammation playing a central role. Portal hypertension (PHT) is also aggravated by inflammation and may subsequently impact the course of ACLF. PHT is more than just an increase in portal pressure in the portal venous system; it aggravates the course of liver disease and, thus, also facilitates the development of acute decompensation and ACLF. A critical mechanistic link between PHT and ACLF might be the gut-liver axis, which is discussed in this review.

Portal hypertensive gastropathy is associated with iron deficiency anemia

“…Interestingly, different etiologies of portal hypertension hold a different likelihood to cause PHG, suggesting additional, non-hemodynamic factors in its pathogenesis [21,49]. In portal hypertension, intrahepatic resistance is increased accompanied by splanchnic vasodilation and decreased systemic vascular resistance [50]. Furthermore, it appears that total gastric blood flow is increased but with decreased mucosal blood flow in the stomach [38].…”

The Role of Macrophage-Inducible C-Type Lectin in Different Stages of Chronic Liver Disease

“…Therefore, the dysregulated mincle signaling might contribute to bacterial translocation and the development toward ACLF. Thus, there exists a clear relationship between portal hypertension and development of ACLF mediated by systemic inflammation ( 13 , 33 ). This relationship is supported by the fact that systemic inflammation can be reduced if the underlying portal hypertension is ameliorated by insertion of a transjugular intrahepatic portosystemic shunt ( 34 – 36 ).…”

“…In more advanced stages of chronic liver disease, an impaired intestinal barrier followed by bacterial translocation into the blood circulation are important events in the development from stable liver cirrhosis toward acute-on-chronic liver failure (ACLF) (13). Infiltrating bacteria or bacterial products lead to chronic systemic inflammation (14).…”

Acute-on-Chronic Liver Failure

“…This includes not only diagnostic but also therapeutic implications as is shown in detail by Trebicka et al [8].…”