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. 2009 May 1;29(9):992-9.
doi: 10.1111/j.1365-2036.2009.03958.x. Epub 2009 Feb 7.

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

J Vlachogiannakos  1 , A S Saveriadis, N Viazis, I Theodoropoulos, K Foudoulis, S Manolakopoulos, S Raptis, D G Karamanolis
Affiliations

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

J Vlachogiannakos et al. Aliment Pharmacol Ther. .

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.

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Comment in

  • Does debugging the portal system decrease pressure?
    De Gottardi A, Garcia-Pagan JC. De Gottardi A, et al. Aliment Pharmacol Ther. 2009 Aug;30(3):309-11; author reply 311-2. doi: 10.1111/j.1365-2036.2009.04029.x. Aliment Pharmacol Ther. 2009. PMID: 19624465 No abstract available.