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

Summary 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.