IDIBELL Seminars. June 15, 2012. At the conference Dr José Such, from the Liver Unit of the General University Hospital of Alicante and CIBERehd, and specialized in bacterial translocation in cirrhotic patients, spoke of translocation and clinical effects. “The cirrhosis causes portal hypertension, which can lead to splanchnic vasodilation, all of which can cause the hyperdynamic syndrome. We intend to see the connection between bacterial translocation, i.e. passage of bacteria through the intestinal wall, with cirrhosis”, said Dr Such. When the intestinal wall is no longer efficient enough to keep bacteria out and they transgress, it can lead to infections. Immune deficiencies may allow bacteria to access and they can operate in different territories.
The detection of bacterial genomic fragments may correspond to viable bacteria or not, leading to infections or inflammatory response, respectively. But, which is the incidence of bacterial translocation in patients with cirrhosis? 42% of patients with ascites showed an increase of lipopolysaccharide binding protein (LBP), proposed as a marker of bacterial translocation, relative to controls. 34% of the patients showed evident signs of translocation. Bacteria in contact with the DNA, which has developed specific receptors, release cytokine, showing an inflammatory response.
After having eaten there is an increase of vasodilation, but portal pressure is equalized. Not so in cirrhotic patients, i.e. they have an endothelial dysfunction. There is a hemodynamic response to inflammation.
“Estudiem pacients de risc: pacients amb cirrosi amb ascites. Aquells pacients que van rebre norfloxacina (Nflx), milloraven la supervivència. La translocació bacteriana pot arribar a causar la mort del pacient, independentment de la funcionalitat hepàtica del mateix”, va explicar el Dr Such.
Bacterial translocation and kidney failure.
“We have studied risk patients: patients with cirrhosis with ascites. Those patients who received norfloxacin (Nflx) improved survival. Bacterial translocation can cause patient death, regardless of liver function”, explained Dr Such.
Applying Norfloxacin stopped translocation, therefore inflammation and mortality. It is necessary to detect the bacteria and, subsequently, to identify it that takes three or four days long.
The vasodilation in different parts of the body plays an important role in pathogenesis. Blocking translocation by Nflx reduces the inflammatory response. Bacterial translocation can be considered as a therapeutic target.
“If we identify the patients at risk, then we apply them the primary prophylaxis, although it is the main problem of potential cases of resistance”, concluded Dr Such.