Patients are presenting and dying from liver disease at an earlier age, the average age of death from liver disease is 59 years of age, compared to 82 – 84 years for heart and lung disease or stroke. Furthermore, patients with liver disease are presenting at an earlier age. Over the last 10 years there has been a 5 – fold increase in the development of cirrhosis in 35 to 55 year olds.
Patients with liver disease are managed mainly within specialist hospital units. The main therapeutic interventions consist of monitoring liver function and the onset of complications associated with the primary liver disease. Patients with compensated liver disease (ie a clinically acceptable stable condition) are discharged from hospital and return for regular monitoring visits. However, many patients are re-admitted to hospital with recurring decompensated liver disease or major complications. For many patients the only option for chronic liver disease is liver transplantation and therapy is designed to manage the disease in the hope that a suitable donor organ can be found.
However, it is becoming evident that chronic liver disease is associated with changes in the gut microbiota. The translocation of bacterial products from the gut is one of the central mechanisms assocaited with the occurrence of cirrhosis in susceptible patients (such as those with NAFLD) and development of complications including hepatic encephalopathy, cariceal bleeding, infection and renal dysfunction. The prolonged use of antibiotics in these patients can lead to antibiotic resistance and causing further changes in the microbial populations in the gut of patients with chronic liver disease.