1 Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA. Electronic address: firstname.lastname@example.org.
2 Division of Gastroenterology Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Patients with chronic liver disease and cirrhosis demonstrate a global mucosal immune impairment, which is associated with altered gut microbiota composition and functionality. These changes progress along with the advancing degree of cirrhosis and can be linked with hepatic encephalopathy, infections and even prognostication independent of clinical biomarkers. Along with compositional changes, microbial functional alterations focused on short-chain fatty acids, bioenergetics and bile acid metabolism are also associated with cirrhosis progression and outcomes. Altering the microbial functional and structural profile is partly achieved by medications used in patients with cirrhosis such as rifaximin, lactulose, proton pump inhibitors and other antibiotics. However, the role of fecal or intestinal microbiota transplantation is being increasingly recognized. The challenges, opportunities and the road ahead for the appropriate and safe use of intestinal microbiota transplantation in liver disease are reviewed, which opens up an exciting field of investigation and therapy in cirrhosis.