Intestinal decontamination improves liver haemodynamics in patients with alcohol-related decompensated cirrhosis.

Abstract

BACKGROUND:

Endotoxaemia is commonly seen in cirrhotic patients with ascites and this may be associated with increased portal pressure.

AIM:

To investigate the effect of intestinal decontamination on liver haemodynamics in alcohol-related cirrhotic patients with ascites.

METHODS:

We included 30 patients. At day 0, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed. Patients received rifaximin (1200 mg/day) for 28 days. At day 29, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed again.

RESULTS:

Median (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45(0-3.1) vs. 0.7(0-2.7), P < 0.0001] and splanchnic circulation [1.8(0-3.4) vs. 0.8(0-2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137). HVPG measurement was possible in 28 patients. Median (range) HVPG values were 18 mmHg (12.7-26.3) on day 0 vs. 14.7 mmHg (7-20) on day 29 (P < 0.0001). HVPG decreased after rifaximin in 23, remained stable in two and increased in three patients.

CONCLUSION:

Hepatic venous pressure gradient values decreased significantly after intestinal decontamination with rifaximin in patients with alcohol-related decompensated cirrhosis and this might have been achieved through significant reduction of plasma endotoxin levels.

• Authors: J Vlachogiannakos, A S Saveriadis, N Viazis, I Theodoropoulos, K Foudoulis, S Manolakopoulos, S Raptis, D G Karamanolis
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 29 Issue 9 Pg. 992-9 (May 01 2009) ISSN: 1365-2036 [Electronic] England
• PMID: 19210289 (Publication Type: Journal Article)

Chemical References

• Anti-Infective Agents
• Endotoxins
• Rifamycins
• Rifaximin

Topics

• Adult
• Aged
• Aged, 80 and over
• Alcohol-Related Disorders
• Anti-Infective Agents (therapeutic use)
• Ascites (drug therapy)
• Endotoxins (metabolism)
• Female
• Humans
• Liver Circulation (drug effects)
• Liver Cirrhosis (blood)
• Male
• Middle Aged
• Rifamycins (administration & dosage)
• Rifaximin
• Treatment Outcome
• Venous Pressure (drug effects)