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Review
. 2014 Oct 28;20(40):14686-95.
doi: 10.3748/wjg.v20.i40.14686.

Gastrointestinal dysfunction in liver cirrhosis

Evangelos Kalaitzakis  1
Affiliations
Review

Gastrointestinal dysfunction in liver cirrhosis

Evangelos Kalaitzakis. World J Gastroenterol. .

Abstract

Patients with liver cirrhosis exhibit several features of gut dysfunction which may contribute to the development of cirrhosis complications as well as have an impact on nutritional status and health-related quality of life. Gastrointestinal symptoms are common in cirrhosis and their pathophysiology probably involves factors related to liver disease severity, psychological distress, and gut dysfunction (e.g., increased gastric sensitivity to distension and delayed gut transit). They may lead to reduced food intake and, thus, may contribute to the nutritional status deterioration in cirrhotic patients. Although tense ascites appears to have a negative impact on meal-induced accommodation of the stomach, published data on gastric accommodation in cirrhotics without significant ascites are not unanimous. Gastric emptying and small bowel transit have generally been shown to be prolonged. This may be related to disturbances in postprandial glucose, insulin, and ghrelin levels, which, in turn, appear to be associated to insulin resistance, a common finding in cirrhosis. Furthermore, small bowel manometry disturbances and delayed gut transit may be associated with the development of small bowel bacterial overgrowth. Finally, several studies have reported intestinal barrier dysfunction in patients with cirrhosis (especially those with portal hypertension), which is related to bacterial translocation and permeation of intestinal bacterial products, e.g., endotoxin and bacterial DNA, thus potentially being involved in the pathogenesis of complications of liver cirrhosis.

Keywords: Gastric accommodation; Gastrointestinal symptoms; Gut motility; Intestinal permeability; Liver cirrhosis; Malnutrition.

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Figures

Figure 1
Figure 1
Gastrointestinal symptom severity assessed as gastrointestinal symptom rating scale scores (means and 95%CI) in patients with liver cirrhosis (continuous line, n = 128) and healthy controls (dashed line, n = 2162). The higher the score in gastrointestinal symptom rating scale (GSRS) the higher the severity of gastrointestinal symptoms. Adapted from the reference [25].
Figure 2
Figure 2
Cumulative percentage of cirrhotics with significant symptoms (n = 16, dotted line), cirrhotics without significant symptoms (n = 24, dashed line) and healthy controls (n = 11, continuous line) reaching maximum satiety during a caloric satiation drinking test. In a caloric satiation drinking test, subjects are asked to consume a liquid caloric meal at a constant rate, scoring their satiation level at 5-min intervals. The test is terminated when the subject reaches maximal satiation. Adapted from the reference [26].
Figure 3
Figure 3
Frequency of transit abnormalities in patients with liver cirrhosis (black bars, n = 42) and healthy controls (white bars, n = 83). Reference values were based on percentiles 10 and 90 of the transit values of healthy controls (n = 83) aP < 0.05, bP < 0.01 vs healthy controls. Adapted from the reference [76].
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