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Abstract
In patients with cirrhosis, the gut microbiome are affected by multiple gut and systemic
alterations. These changes lead to dysbiosis in the microbiota of different parts
of the body, resulting in inflammation. The constant immune stimulation resulting
in part from dysbiosis is associated with morbidity in patients with cirrhosis. Dysbiosis
as a dynamic event worsens with decompensation such as with hepatic encephalopathy,
infections or acute-on-chronic liver failure (ACLF). These microbial patterns could
be applied as diagnostic and prognostic measures in cirrhosis in the outpatient and
inpatient setting. Current therapies for cirrhosis have differing impacts on gut microbial
composition and functionality. Dietary modifications and the oral cavity have emerged
as newer targetable factors to modulate the microbiome, which could affect inflammation
and, potentially improve outcomes. Additionally, fecal microbial transplant is being
increasingly studied to provide compositional and functional modulation of the microbiome.
Ultimately, a combination of targeted therapies may be needed to provide an optimal
gut milieu to improve outcomes in cirrhosis.