Recent advances in clinical practice INFECTION, COAGULATION, AND VARICEAL BLEEDING IN CIRRHOSIS

Correspondence to: Professor A K Burroughs, Liver Transplantation and Hepatobiliary, Medicine Unit, Royal Free Hospital, Pond St, London NW3 2QG, UK; Andrew.Burroughs@ royalfree.nhs.uk _________________________ SUMMARY Bacterial infections in cirrhotic patients are common. There is a predisposition to intestinal bacterial overgrowth, intestinal dysmotility, and increased intestinal permeability, all leading to an increase in bacterial translocation. Bacterial translocation is the probable mechanism for some of the most common infections in cirrhosis, such as spontaneous bacterial peritonitis, but is also the source of bacterial byproducts such as endotoxin which can cause an increase in portal pressure, impairment of liver function, and worsening of haemostasis. The effects of bacterial infection and bacterial products on portal and systemic haemodynamics in cirrhosis and clinical data on infection, from both retrospective and prospective studies of variceal bleeding and other settings, demonstrate the importance of infection in pathophysiological mechanisms in cirrhosis. This has been followed by recent clinical evidence that antibiotic therapy reverses systemic vasodilation and prevents early variceal rebleeding.