Endotoxaemia is commonly seen in cirrhotic patients with ascites and
this may be associated with increased portal pressure.
To investigate the effect of intestinal decontamination on liver
haemodynamics in alcohol-related cirrhotic patients with ascites.
We included 30 patients. At day 0, systemic and splanchnic circulation
endotoxin levels were determined and HVPG measurement performed.
Patients received rifaximin (1200 mg/day) for 28 days. At day 29,
systemic and splanchnic circulation endotoxin levels were determined and
HVPG measurement performed again.
Median (range) plasma endotoxin levels decreased significantly after
rifaximin administration both in systemic [1.45(0-3.1) vs. 0.7(0-2.7),
P < 0.0001] and splanchnic circulation [1.8(0-3.4) vs. 0.8(0-2.1), P <
0.0001]. Meanwhile, the difference seen in endotoxin levels between the
splanchnic and systemic circulation at day 0 (P = 0.001) was not noted
at day 29 (P = 0.137). HVPG measurement was possible in 28 patients.
Median (range) HVPG values were 18 mmHg (12.7-26.3) on day 0 vs. 14.7
mmHg (7-20) on day 29 (P < 0.0001). HVPG decreased after rifaximin in
23, remained stable in two and increased in three patients.
Hepatic venous pressure gradient values decreased significantly after
intestinal decontamination with rifaximin in patients with
alcohol-related decompensated cirrhosis and this might have been
achieved through significant reduction of plasma endotoxin levels
