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Gut microbiota abnormalities, small intestinal bacterial overgrowth, and non-alcoholic fatty liver disease: An emerging paradigm

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Abstract

Evidence accumulates to implicate a role for the gut microbiota in non-alcoholic fatty liver disease (NAFLD)—a disorder that has reached almost epidemic proportions around the globe. For some time a disturbance in the gut microbiome, small intestinal bacterial overgrowth (SIBO), has been described among patients with liver disease, in general, and in the development and progression of NAFLD to nonalcoholic steatohepatitis (NASH), decompensated liver disease and hepatocellular cancer (HCC), in particular. More recently and permitted by the advent of high-throughput sequencing and allied molecular techniques, a much more detailed analysis of gut microbiota in NAFLD and NASH has become possible. In animal models, several mechanisms have been delineated which reveal how gut bacteria and their products could promote steatosis, hepatic inflammation, fibrosis, cirrhosis, and carcinogenesis. For understandable reasons evidence from human studies is less complete, but here again a plausible case is beginning to emerge to incriminate microbiota in NAFLD and NASH pathogenesis. Therapeutic interventions based on the modulation of the microbiome have been explored to some extent, but their application to everyday medical practice is still in the future.

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Acknowledgement

The authors thank Ms. Shikha Agnihotri, M.Sc., Ms. Sushmita Rai, Department of Gastroenterology, and Mr. Anil, Medical Illustration Unit, SGPGI, Lucknow for their help. The authors also thank Prof. Gerald Holtmann, University of Brisbane, Australia for providing the photograph of Brisbane biospy forceps.

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  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Uday C. Ghoshal, Amit Goel & Eamonn M. M. Quigley

  2. Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, 6550 Fannin St, SM 1201, Houston, TX, 77030, USA

    Eamonn M. M. Quigley

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Ghoshal, U.C., Goel, A. & Quigley, E.M.M. Gut microbiota abnormalities, small intestinal bacterial overgrowth, and non-alcoholic fatty liver disease: An emerging paradigm. Indian J Gastroenterol 39, 9–21 (2020). https://doi.org/10.1007/s12664-020-01027-w

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