Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2024; 30(31): 3668-3679
Published online Aug 21, 2024. doi: 10.3748/wjg.v30.i31.3668
Alterations in the gut microbiome after transjugular intrahepatic portosystemic shunt in patients with hepatitis B virus-related portal hypertension
Hong-Wei Zhao, Jin-Long Zhang, Fu-Quan Liu, Zhen-Dong Yue, Lei Wang, Yu Zhang, Cheng-Bin Dong, Zhen-Chang Wang
Hong-Wei Zhao, Zhen-Chang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Hong-Wei Zhao, Jin-Long Zhang, Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Fu-Quan Liu, Zhen-Dong Yue, Lei Wang, Yu Zhang, Cheng-Bin Dong, Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Zhao HW and Wang ZC designed the research study; Zhang JL, Yue ZD, Wang L, Zhang Y, and Dong CB performed experiments and drafted the original paper; Zhao HW and Zhang JL analyzed the data; Zhao HW and Liu FQ reviewed the manuscript; Wang ZC approved the final version to be published.
Institutional review board statement: The present research was conducted following the ethical standards outlined in the 1964 Declaration of Helsinki and its subsequent amendments, or similar ethical standards. Moreover, this study received approval from the Ethics Committee/Institutional Review Board of Beijing Shijitan Hospital (2019 Scientific Research Review Approval No. 2).
Clinical trial registration statement: This study was not registered at www.chictr.org.cn or other website.
Informed consent statement: Before the procedures, all participants or their authorized representatives provided written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset is available from the corresponding author upon request at cjr.wzhch@vip.163.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Chang Wang, MD, Professor, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. cjr.wzhch@vip.163.com
Received: March 11, 2024
Revised: July 11, 2024
Accepted: August 2, 2024
Published online: August 21, 2024
Processing time: 154 Days and 21.2 Hours
Abstract
BACKGROUND

Gut microbiota (GM) affects the progression and response to treatment in liver diseases. The GM composition is diverse and associated with different etiologies of liver diseases. Notably, alterations in GM alterations are observed in patients with portal hypertension (PH) secondary to cirrhosis, with hepatitis B virus (HBV) infection being a major cause of cirrhosis in China. Thus, understanding the role of GM alterations in patients with HBV infection-related PH is essential.

AIM

To evaluate GM alterations in patients with HBV-related PH after transjugular intrahepatic portosystemic shunt (TIPS) placement.

METHODS

This was a prospective, observational clinical study. There were 30 patients (with a 100% technical success rate) recruited in the present study. Patients with esophagogastric variceal bleeding due to HBV infection-associated PH who underwent TIPS were enrolled. Stool samples were obtained before and one month after TIPS treatment, and GM was analyzed using 16S ribosomal RNA amplicon sequencing.

RESULTS

One month after TIPS placement, 8 patients developed hepatic encephalopathy (HE) and were assigned to the HE group; the other 22 patients were assigned to the non-HE group. There was no substantial disparity in the abundance of GM at the phylum level between the two groups, regardless of TIPS treatment (all, P > 0.05). However, following TIPS placement, the following results were observed: (1) The abundance of Haemophilus and Eggerthella increased, whereas that of Anaerostipes, Dialister, Butyricicoccus, and Oscillospira declined in the HE group; (2) The richness of Eggerthella, Streptococcus, and Bilophila increased, whereas that of Roseburia and Ruminococcus decreased in the non-HE group; and (3) Members from the pathogenic genus Morganella appeared in the HE group but not in the non-HE group.

CONCLUSION

Intestinal microbiota-related synergism may predict the risk of HE following TIPS placement in patients with HBV-related PH. Prophylactic microbiome therapies may be useful for preventing and treating HE after TIPS placement.

Keywords: Transjugular intrahepatic portosystemic shunt; Hepatic encephalopathy; Gut microbiota; Hepatitis B virus; Portal hypertension

Core Tip: Gut microbiota (GM) alterations have been demonstrated in patients with portal hypertension, influencing hepatic encephalopathy (HE) development. The present study analyzes the changes in GM composition in Chinese patients with hepatitis B virus related portal hypertension before and after transjugular intrahepatic portosystemic shunt (TIPS). The results revealed that patients without HE exhibited higher GM-related synergism than those with HE, regardless of TIPS placement. Thus, the synergism of intestinal microbiota may serve as a useful indicator to predict the risk of HE after TIPS placement.