Abstract
Background & aims
Cirrhosis and its complications may affect gut microbiota (GM) composition. Transjugular
intrahepatic portosystemic shunt (TIPS) represents the most effective treatment for
portal hypertension (PH). We aimed to evaluate whether TIPS placement modifies GM
composition and metabolic function.
Methods
A compositional and functional GM analysis was prospectively performed in 13 cirrhotic
patients receiving TIPS. Patients receiving systemic or non-absorbable antibiotics
for any indications were excluded. Fecal samples were collected before and three months
after TIPS. GM was analyzed by 16S ribosomal RNA sequencing. Small- and medium-chain
fatty acids (SCFAs and MCFAs, respectively) were measured by gas chromatography/mass
spectrometry.
Results
TIPS placement resulted in a mean 48% reduction in portal-caval pressure gradient.
No recurrence of PH related complications was observed. After TIPS, increased levels
of Flavonifractor spp. (p = 0.049), and decreased levels of Clostridiaceae (p = 0.024), these latter linked to abdominal infections in cirrhotic patients, were
observed. No differences were found in the SCFAs signature while analysis of MCFA
profiles showed a decreased abundance of pro-inflammatory isohexanoic (p<0.01), 2-ethylhexanoic (p<0.01) and octanoic acids (p<0.01) after TIPS.
Conclusion
Correction of PH following TIPS results in modifications of GM composition which could
be potentially beneficial and reduces the levels of fecal pro-inflammatory MCFAs.
Keywords
List of abbreviations:
TIPS (transjugular intrahepatic portosystemic shunt), PH (portal hypertension), GM (gut microbiota), SCFAs (small-chain fatty acids), MCFAs (middle-chain fatty acids), HE (hepatic encephalopathy), RA (refractory ascites), MELD (Model for end-stage liver disease), PSPG (porto-systemic pressure gradient), OUT (operational taxonomic unit), AUD (alcohol use disorder), PCoA (Principal Coordinate Analysis), NAFLD (non-alcoholic fatty liver disease), NASH (non-alcoholic steatohepatitis (NASH))To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 16, 2022
Accepted:
November 21,
2022
Received:
July 14,
2022
Editor: Roberto de FranchisPublication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
