Gut microbiota modulation in cirrhosis: a new frontier in hepatology.

Bajaj JS et al. (1) recently published a study in APT about gut microbiota modulation and consequences in cirrhotic patients. Cirrhotic patients with MHE patients were randomised 1:1 into LGG or placebo for 8 weeks. The aim was to determine gut microbiota composition and concomitant changes in function (metabolome) in cirrhotic patients with minimal hepatic encephalopathy (MHE). Serum, urine and stool samples were collected at baseline and study end. Safety was assessed at weeks 4 and 8. Endotoxin and systemic inflammation, microbiome using multi-tagged pyrosequencing, serum/urine metabolome were analysed between groups using correlation networks. Thirty MHE patients (14 LGG and 16 placebo) completed the study without any differences in serious adverse events. Only in the LGG-randomised group, endotoxemia and TNF-a decreased, microbiome changed (reduced Enterobacteriaceae and increased Clostridiales Incertae Sedis XIV and Lachnospiraceae relative abundance) with changes in metabolite/microbiome correlations pertaining to amino acid, vitamin and secondary BA metabolism.