Gut microflora in the pathogenesis of the complications of cirrhosis

被引:163
作者
Garcia-Tsao, G
机构
[1] Yale Univ, Sch Med, Serv Gastroenterol, VA Connecticut Healthcare Syst, New Haven, CT 06520 USA
[2] Yale Univ, Sch Med, Sect Digest Dis, New Haven, CT 06520 USA
[3] Univ Regensburg, Dept Internal Med, D-8400 Regensburg, Germany
关键词
cirrhosis; gut flora; spontaneous bacterial peritonitis; hyperdynamic circulation; hepatic encephalopathy; bacterial translocation; intestinal bacterial overgrowth; intestinal permeability;
D O I
10.1016/j.bpg.2003.10.005
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The gut flora plays an important role in the pathogenesis of the complications of cirrhosis. Cirrhotic patients are prone to develop bacterial infections, mainly the 'spontaneous' infection of ascites or spontaneous bacterial peritonitis. Other complications of cirrhosis, such as variceal haemorrhage and ascites, occur mostly or solely as a consequence of portal hypertension. Portal pressure increases initially as a consequence of an increased intrahepatic resistance but, once collaterals; have formed, high portal pressure is maintained by an increased splanchnic blood inflow secondary to vasodilatation. Splanchnic vasodilatation is the initiating event in the hyperdynamic circulatory state that aggravates the complications of cirrhosis. The gut flora plays a role in both the development of infections and in the hyperdynamic circulatory state of cirrhosis and, although less prominently, it also plays a role in the pathogenesis of hepatic encephalopathy. This chapter presents evidence regarding gut flora and its modification in the pathogenesis and management of these complications of cirrhosis.
引用
收藏
页码:353 / 372
页数:20
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