Colucci G, Stella S, Castagnetti A, Di Rito L, Lucà M, Tosetti G, D’Ambrosio R, Lampertico P. Gut microbiome in patients with cirrhosis and clinically significant portal hypertension: A pilot study. World J Hepatol 2026; 18(10): 124666 [DOI: 10.4254/wjh.124666]
Corresponding Author of This Article
Giuseppe Colucci, MD, Associate Research Scientist, Division of Gastroenterology and Hepatology, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, via F. Sforza 28, Milan 20122, Italy. giuseppe.colucci@guest.unimi.it
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Colucci G, Stella S, Castagnetti A, Di Rito L, Lucà M, Tosetti G, D’Ambrosio R, Lampertico P. Gut microbiome in patients with cirrhosis and clinically significant portal hypertension: A pilot study. World J Hepatol 2026; 18(10): 124666 [DOI: 10.4254/wjh.124666]
World J Hepatol. Oct 27, 2026; 18(10): 124666 Published online Oct 27, 2026. doi: 10.4254/wjh.124666
Gut microbiome in patients with cirrhosis and clinically significant portal hypertension: A pilot study
Giuseppe Colucci, Sonia Stella, Andrea Castagnetti, Laura Di Rito, Martina Lucà, Giulia Tosetti, Roberta D’Ambrosio, Pietro Lampertico
Giuseppe Colucci, Sonia Stella, Martina Lucà, Giulia Tosetti, Roberta D’Ambrosio, Division of Gastroenterology and Hepatology, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
Andrea Castagnetti, Laura Di Rito, Wellmicro Laboratories, Bologna 40100, Italy
Pietro Lampertico, CRC “A. M. and A. Migliavacca”, Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
Co-first authors: Giuseppe Colucci and Sonia Stella.
Author contributions: Colucci G designed and coordinated the research study, analyzed the data and wrote the manuscript; Stella S collected and managed fecal samples; Colucci G and Stella S contributed equally to this article, they are the co-first authors of this manuscript; Castagnetti A and Di Rito L performed the research and provided experimental results; Lucà M and Tosetti G selected patients and collected clinical data; D’Ambrosio R and Lampertico P reviewed the data and the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: No AI has ever been used in this study design, implementation and analysis.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Comitato Etico Milano Area 2, approval No. 1037_2022.
Clinical trial registration statement: Not applicable.
Informed consent statement: The subjects have signed the informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All data can be shared as for the Journal SOP.
Corresponding author: Giuseppe Colucci, MD, Associate Research Scientist, Division of Gastroenterology and Hepatology, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, via F. Sforza 28, Milan 20122, Italy. giuseppe.colucci@guest.unimi.it
Received: June 26, 2026 Revised: August 1, 2026 Accepted: September 20, 2026 Published online: October 27, 2026 Processing time: 117 Days and 17.9 Hours
Abstract
BACKGROUND
An altered intestinal microbiota may affect the gut-liver axis and influence the outcome of patients with cirrhosis and clinically significant portal hypertension (CSPH).
AIM
To analyze microbiota and mycobiota in patients with cirrhosis and CSPH to identify pathological profiles amenable to treatment.
METHODS
Twenty-five patients with cirrhosis and CSPH were recruited and compared to 25 healthy controls (HC). The 16S rRNA hypervariable regions V3 and V4 (bacterial component) and the ITS2 region (fungal component) isolated from fecal DNA, sequenced on the MiSeq - Illumina®, were analyzed using the QIIME2 (v.2021.11) and DADA2 (v.1.16) software.
RESULTS
Patients’ microbiota included 5 phyla, Actinobacteria (2.4%), Bacteroidetes (35%), Firmicutes (57%), Protobacteria (2.5%), and Elusimicrobia (3%) with significant differences compared to HC in the proportion of Elusimicrobia (3% vs 1%, P < 0.001), Protebacteria (2.5% vs 1.4%, P < 0.003) and Verrucomicrobia (0.1% vs 0.34%, P < 0.004). Pathobionts were detected in the microbiota of 6 (26%) patients, mainly Escherichia Coli and Klebsiella Pneumoniae, and in the mycobiota of 8 (32%) patients, mostly Malassezia Restricta and Candida Albicans. Six patients showed mixed infections with both micro and mycobiota pathobionts. Overall, 20 patients (86%) were affected. The Dysbiosis and Diversity Indexes were also significantly different in patients vs HC (median 2.2 vs 1.3, P < 0.01, and 74 vs 130, P < 0.01).
CONCLUSION
Differences in the microbiome composition, dysbiosis and biodiversity indexes between patients and HC, the presence of bacterial and fungal pathobionts suggest an active role of the microbiome in cirrhosis with CSPH.
Core Tip: The gut-liver axis is affected in cirrhosis with clinically significant portal hypertension and may contribute to disease progression and liver decompensation. In a group of patients recruited in a pilot study, we detected significant differences in the intestinal microbiota and mycobiota compared to healthy controls, including the presence of specific pathobionts. Dietary modifications and the supplementation of specific pre and probiotics may help preventing disease progression in patients with cirrhosis and clinically significant portal hypertension.
