Ultrastructural characteristics of distal duodenum mucosa in patients with cirrhosis

Such, José; Guardiola, José V.; Juan, J. De; Casellas, Juan Antonio; Pascual, Sonia; Aparicio, José Ramón; Sola-Vera, Javier; Pérez‐Mateo, Miguel

doi:10.1097/00042737-200204000-00006

Cited by 73 publications

(52 citation statements)

References 20 publications

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“…Cytokines such as IL-1β and TNF are known to cause a disruption of tight junctions [45] . In one study, distension of the intercellular s�aces below these tight junctions was observed in duode� nal bio�sies of cirrhotic �atients [46] . Alcoholic �atients without liver cirrhosis that cease alcohol consumption demonstrated higher intestinal permeability in 3 d by way of a chro�iu��51�EDTA absor�tion test.…”

Section: Disruption Of the Intestinal Barrier Function As Mechanism Fmentioning

confidence: 97%

Bacterial translocation and changes in the intestinal microbiome associated with alcoholic liver disease

Yan¹

2012

WJH

101

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Alcoholic liver disease progresses through several stages of tissue damage, from simple steatosis to alcoholic hepatitis, fibrosis, or cirrhosis. Alcohol also affects the intestine, increases intestinal permeability and changes the bacterial microflora. Liver disease severity correlates with levels of systemic bacterial products in patients, and experimental alcoholic liver disease is dependent on gut derived bacterial products in mice. Supporting evidence for the importance of bacterial translocation comes from animal studies demonstrating that intestinal decontamination is associated with decreased liver fibrogenesis. In addition, mice with a gene mutation or deletion encoding receptors for either bacterial products or signaling molecules downstream from these receptors, are resistant to alcohol-induced liver disease. Despite this strong association, the exact molecular mechanism of bacterial translocation and of how changes in the intestinal microbiome contribute to liver disease progression remains largely unknown. In this review we will summarize evidence for bacterial translocation and enteric microbial changes in response to alcoholic liver injury and chronic alcoholic liver disease. We will further describe consequences of intestinal dysbiosis on host biology. We finally discuss how therapeutic interventions may modify the gastrointestinal microflora and prevent or reduce alcoholic liver disease progression

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Section: Disruption Of the Intestinal Barrier Function As Mechanism Fmentioning

confidence: 97%

Bacterial translocation and changes in the intestinal microbiome associated with alcoholic liver disease

Yan¹

2012

WJH

101

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“…The pathophysiologic mechanisms are not totally understood and several factors may be involved. Malabsorption has been implicated and this was presumed to be related to changes in the SB villi [2,4,5] . For example, Such et al [4] investigated 6 patients with cirrhosis using jejunal biopsies, and studied the mucosa under electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Malabsorption has been implicated and this was presumed to be related to changes in the SB villi [2,4,5] . For example, Such et al [4] investigated 6 patients with cirrhosis using jejunal biopsies, and studied the mucosa under electron microscopy. The authors observed that "the microvilli were reduced in number and appeared shorter and thicker when compared to controls", and their conclusion was that "the total absorptive surface may be reduced in cirrhotic patients".…”

Section: Discussionmentioning

confidence: 99%

“…CD may, therefore, be underdiagnosed in cirrhosis. Studies of SB biopsy in cirrhosis [1][2][3][4][5] , have thus shed doubt on the validity of biopsy in the diagnosis of CD in cirrhotic patients; but reported findings are poorly characterized, lack standardized grading, and of unclear significance. The current study was undertaken to determine if SB biopsies in cirrhosis show features that might mimic CD.…”

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Wakim-Fleming¹,

Zein²,

Bennett³

et al. 2008

WJG

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INTRODUCTIONStudies of small bowel (SB) mucosa in cirrhosis and portal hypertension report a diverse spectrum of histological abnormalities [1][2][3][4][5] . These include increased capillary angiogenesis, mucosal edema, decreased villus to crypt ratio, villus atrophy and decreased total absorptive surface. Villus abnormalities resemble the abnormalities of coeliac disease (CD) and this may affect the interpretation of small bowel biopsy, and lead to confusion when CD is to be excluded in patients with cirrhosis and portal hypertension.The diagnosis of CD is increasingly considered and work up recommended during the evaluation of abnormal liver enzymes [6][7] . This is in part due to the heightened awareness of the association of CD with a variety of liver disorders. Most commonly described associated liver disorders include autoimmune hepatitis, primary biliary cirrhosis, non-alcoholic fatty liver disease, unexplained abnormal liver tests and cirrhosis [8][9][10][11][12][13][14][15] . The mechanisms of this association are not clear and the prevalence of CD in patients with liver disease is variable depending on the associated liver disease. For example, while CD affects 1% of the general population, one study reports that about 4% of 185 cirrhotic patients who had undergone liver transplantation were found to have CD, and 3 of 4 pa- Abstract AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis www.wjgnet.comWakim-Fleming J et al . Cirrhosis with portal hypertension does not cause atrophy of the small bowel mucosa 6371

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Pathogenesis and Clinical Features of Spontaneous Bacterial Peritonitis

Such¹,

Guarner²,

Runyon³

2005

Ascites and Renal Dysfunction in Liver Disease

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Ultrastructural characteristics of distal duodenum mucosa in patients with cirrhosis

Abstract: The epithelial layers from cirrhotic patients show ultrastructural abnormalities. However, it is not known if the observed alterations are related to the presence of increased intestinal permeability or to bacterial translocation, which are frequently found in these patients.

Cited by 73 publications

References 20 publications

Bacterial translocation and changes in the intestinal microbiome associated with alcoholic liver disease

Bacterial translocation and changes in the intestinal microbiome associated with alcoholic liver disease

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Pathogenesis and Clinical Features of Spontaneous Bacterial Peritonitis

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