Influence of Gut–Liver Axis on Portal Hypertension in Advanced Chronic Liver Disease: The Gut Microbiome as a New Protagonist in Therapeutic Management

Clinically significant portal hypertension is associated with most complications of advanced chronic liver disease (ACLD), including variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. Gut dysbiosis a hallmark ACLD consists the overgrowth potentially pathogenic bacteria decrease in autochthonous bacteria; additionally, congestion makes intestinal barrier more permeable to their products, which contributes development through inflammatory mechanisms. This review summarizes current knowledge on role gut–liver axis pathogenesis hypertension, focus therapies targeting gut microbiota. The modulation microbiota several levels represents major challenge upcoming years; in-depth characterization molecular microbiological mechanisms linking bidirectional relationship could pave way identification new therapeutic targets for innovative management ACLD.