Immune Dysfunction and Infections in Patients With Cirrhosis

Alexander R. Bonnel; Chalermrat Bunchorntavakul; K. Rajender Reddy

Disclosures

Clin Gastroenterol Hepatol. 2011;9(9):727-738. 

In This Article

Bacterial Translocation

Bacterial translocation is the migration of bacteria or bacterial products from the intestinal lumen to mesenteric lymph nodes (Figure 2).[24] Bacterial translocation is known to be increased in cirrhosis and has been pathogenetically linked to the development of SBP.[5,6] It has also been implicated as a cause of recurrent SBP.[25] Patients with cirrhosis have slowed intestinal motility, which leads to intestinal bacterial overgrowth.[26] This overgrowth, along with portosystemic shunting, enables perpetuation of bacteria and can lead to bacteremia. Further oxidative damage from increased endotoxins, proinflammatory cytokines, and nitric oxide (NO) alter the structure and permeability of intestinal mucosa in cirrhosis.[24] In conjunction with the decreased local and impaired systemic immune function in cirrhosis, decreased gut motility and increased permeability facilitate the spread of intestinal bacteria to extraintestinal sites and predispose patients with cirrhosis to infections.

Figure 2.

Pathogenesis of SBP

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