Intestinal decontamination improves liver haemodynamics in patients with alcohol-related decompensated cirrhosis
Article first published online: 7 FEB 2009
© 2009 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 29, Issue 9, pages 992–999, May 2009
How to Cite
VLACHOGIANNAKOS, J., SAVERIADIS, A. S., VIAZIS, N., THEODOROPOULOS, I., FOUDOULIS, K., MANOLAKOPOULOS, S., RAPTIS, S. and KARAMANOLIS, D. G. (2009), Intestinal decontamination improves liver haemodynamics in patients with alcohol-related decompensated cirrhosis. Alimentary Pharmacology & Therapeutics, 29: 992–999. doi: 10.1111/j.1365-2036.2009.03958.x
- Issue published online: 1 APR 2009
- Article first published online: 7 FEB 2009
- Publication data Submitted 7 October 2008 First decision 13 November 2008 Resubmitted 14 January 2009 Accepted 3 February 2009 Epub Accepted Article 7 February 2009
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.