Gut feeling gone wrong: Tangled relationship between disorders of gut-brain interaction and liver disease

Abstract

Functional gastrointestinal disorders, now termed “disorders of gut-brain interaction” (DGBI), are characterized by a spectrum of chronic gastrointestinal symptoms driven by dysregulated gut-brain interaction. DGBIs frequently coexist with liver diseases, including cirrhosis, thereby exacerbating clinical manifestations and complicating management; this overlap is underpinned by shared mechanisms, including gut dysbiosis, increased intestinal permeability, systemic inflammation, and altered neuroimmune signaling. Portal hypertension in cirrhosis promotes small intestinal bacterial overgrowth and microbial translocation, thereby triggering inflammatory pathways that worsen gut and liver function. This minireview explores the gut-liver axis as a central mediator in the interplay between DGBIs and liver disease/cirrhosis. Clinically, these interactions manifest as refractory gastrointestinal symptoms, nutritional deficiencies, and impaired quality of life. Emerging research emphasizes the need for integrative diagnostic approaches, such as combining advanced imaging, microbiome analysis, and biomarker profiling, to unravel the complex interplay between DGBIs and liver disease/cirrhosis. Therapeutic interventions targeting the gut microbiome, neuroimmune pathways, and lifestyle modification can mitigate disease burden. This review underscores the importance of a multidisciplinary framework for enhancing patient outcomes and guiding future research in this intersectional field.

Keywords: Disorders of gut-brain interaction; Liver diseases; Gut-liver axis; Dysbiosis; Cirrhosis; Intestinal permeability; Neuroimmune dysregulation

Core Tip: The review highlights the complex bidirectional relationship between disorders of gut-brain interaction and liver diseases, particularly cirrhosis. It emphasizes shared pathophysiological mechanisms such as gut dysbiosis, increased intestinal permeability, and neuroimmune dysregulation, which exacerbate clinical manifestations and complicate management. The article suggests integrative diagnostic approaches and therapeutic strategies targeting the gut microbiome and neuroimmune pathways to improve patient outcomes.