Abstract
BackgroundGut microbiota may be altered in patients with cirrhosis, and may further change after administration of lactulose. We studied the composition of gut microbiota in patients with cirrhosis and assessed the effect on it of lactulose administration.MethodsStool specimens were collected from 35 patients with cirrhosis (male 26; median [range] age: 42 [29–65] years) and 18 healthy controls (male 14; 44.5 [24–67] years); 21 patients provided another specimen after lactulose administration for 55 [42–77] days. For each, a DNA library of V3 region of bacterial 16S ribosomal RNA was subjected to paired-end Illumina sequencing. Inter-specimen relationship was studied using principal co-ordinate analysis. Abundances of various bacterial taxa, and indices of alpha and beta diversity were compared, between patients and controls, and between specimens collected before and after lactulose.ResultsGut microbiota from cirrhosis patients and controls showed differential clustering, and microbiota from patients with cirrhosis had less marked alpha diversity. Abundances of dominant phyla (Bacteroidetes, Firmicutes and Proteobacteria) were similar. However, patients with cirrhosis had lower abundances of five phyla, namely Tenericutes, Cyanobacteria, Spirochaetes, Elusimicrobia and Lentisphaerae, and differences in abundances of several families and genera than in controls. Lactulose administration did not lead to any change in alpha and beta diversities, species richness and abundances of various bacterial taxa in gut microbiota.ConclusionsGut microbiota in cirrhosis differ from healthy persons and do not change following lactulose administration. The latter suggests that the effect of lactulose on hepatic encephalopathy may not be related to alteration in gut microbiota.
Highlights
Gut microbiota may be altered in patients with cirrhosis, and may further change after administration of lactulose
With its strategic placement between the bowel and the systemic circulation, liver acts as a filter and removes any bacteria and their harmful products that may enter the blood from the gut [2]; the loss of this function in patients with cirrhosis may play a role in Sarangi et al BMC Gastroenterology (2017) 17:125 the occurrence of complications such as spontaneous bacterial peritonitis, sepsis and hepatorenal syndrome [3]
Using a culture-independent, next-generation sequencing technique, we found that composition of intestinal microbiota in patients with cirrhosis was significantly different from that in healthy persons, as evidenced by differential clustering of patients and healthy persons on principal co-ordinate analysis (PCoA)
Summary
Gut microbiota may be altered in patients with cirrhosis, and may further change after administration of lactulose. The number of bacterial cells in the intestinal lumen of an individual is of the order of that of human cells in the body These bacteria perform several important physiologic functions, such as digestion of complex carbohydrates leading to energy salvage, synthesis of essential substances such as vitamin K, and modulation of mucosal and systemic immune responses [1]. With its strategic placement between the bowel and the systemic circulation, liver acts as a filter and removes any bacteria and their harmful products that may enter the blood from the gut [2]; the loss of this function in patients with cirrhosis may play a role in Sarangi et al BMC Gastroenterology (2017) 17:125 the occurrence of complications such as spontaneous bacterial peritonitis, sepsis and hepatorenal syndrome [3]
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