Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VAMC, United States.
Periodontics, Virginia Commonwealth University Medical Center.
GI, McGuire VA Medical Center.
Peridontics, Virginia Commonwealth University.
Virginia Commonwealth University.
George Mason University.
Microbiome Analysis Center, George Mason University.
Periodontic, Virginia Commonwealth University.
Cirrhosis is associated with a systemic pro-inflammatory milieu, endotoxemia and gut dysbiosis. The oral cavity could be an additional source of inflammation. We aimed to determine the effect of periodontal therapy in cirrhosis through evaluating endotoxemia, inflammation, cognition and quality of life (QOL). Age-matched cirrhotic/non-cirrhotic subjects exhibiting chronic gingivitis and/or mild/moderate periodontitis underwent periodontal therapy with follow-up at 30 days. Saliva/stool for microbial composition and serum for MELD score, endotoxin and lipopolysaccharide binding protein (LBP) and immune-inflammatory markers (IL-1β, IL-6, histatins 1, 3, 5 and lysozyme) were collected at baseline and day 30. The cognitive function and QOL were also evaluated similarly. A separate group of cirrhotic patients were followed for the same duration without periodontal therapy. Cirrhotics, especially those with hepatic encephalopathy (HE), demonstrated improved dysbiosis in stool and saliva, and improved endotoxin, LBP and salivary/serum inflammatory mediators following periodontal therapy. These parameters, which were higher in HE at baseline, became statistically similar post-therapy. Pre vs post-therapy QOL and cognition also improved in HE patients following oral interventions. On the other hand, LBP and endotoxin increased over time in cirrhotics not receiving therapy, rest of the parameters, including microbiota remained similar over time in the no-therapy group. This proof-of-concept study demonstrates that periodontal therapy in cirrhosis, especially in those with HE, is associated with improved oral and gut dysbiosis, systemic inflammation, MELD score and cognitive function, which was not observed in those who did not receive therapy over the same time-period.