Effect of Transjugular Intrahepatic Portosystemic Shunt on Intestinal Flora in Liver Cirrhosis: A Systematic Review.

BACKGROUND: Liver cirrhosis disturbs the gut-liver axis, causing microbial imbalance and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is a common method of managing portal hypertension, but it may predispose to hepatic encephalopathy (HE). The relationship between TIPS, intestinal microbiota, and HE is an active field of study, and there is increasing evidence to indicate that portal hypertension itself can lead to changes in microbes. PURPOSE: To comprehensively assess the impact of TIPS on the gut microbiota of cirrhotic patients and to determine its correlation with clinical outcomes, especially HE. METHODS: A systematic search of prospective and cross-sectional studies was conducted. Studies included evaluated gut microbial composition pre- and post-TIPS with 16S rRNA sequencing and metabolomic profiling. RESULTS: Transjugular intrahepatic portosystemic shunt is not linked to a consistent pattern of microbes but is linked to fluctuating changes. The direction of these changes seems to be dependent on clinical outcomes. Increased production of short-chain fatty acids (SCFAs) by bacteria, such as Coprococcus and Roseburia, is associated with a reduced incidence of HE, which is reported in some cohorts at around 13%. Conversely, the increase in potentially pathogenic genera such as Haemophilus and Morganella, along with the loss of beneficial taxa, is associated with a 68% increase in HE rates. The metabolomic data also reveal an inverse correlation between some circulating conjugated bile acids and the severity of HE. There is also comparative evidence that portal hypertension and not cirrhosis per se may be central to the development of dysbiosis. CONCLUSION: Transjugular intrahepatic portosystemic shunt has different impacts on the gut microbiome in different patients and affects the risk of HE. Maintaining positive microbial communities could provide a foundation for risk assessment and intervention.