Z Gastroenterol 2015; 53 - KG166
DOI: 10.1055/s-0035-1559192

Duodenal microbiota is not the predominent origin for bacterial translocation in liver cirrhosis

S Krohn 1, C Engelmann 1, P Raatz 1, A Böhlig 1, K Zeller 1, S Böhm 1, A Chatzinotas 2, A Hoffmeister 3, T Berg 1
  • 1Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Hepatologie, Leipzig, Deutschland
  • 2Helmholtz-Zentrum für Umweltforschung-UFZ, Umweltmikrobiologie, Leipzig, Deutschland
  • 3Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Interdisziplinäre zentrale Endoskopie, Leipzig, Deutschland

Background and aims: Intestinal dysbiosis and bacterial translocation (BT) in cirrhosis has been regarded as the main driver for infections. However, results regarding the intestinal origin of BT are conflicting. Although the small intestine has been considered having the greatest potential for BT further results promoted that bacteria mainly translocate from the colon. We therefore investigated duodenal fluid and blood of patients with cirrhosis in terms of its bacterial DNA (bactDNA) content and composition.

Methods: 156 blood and duodenal samples were collected in patients with cirrhosis (n = 114) and controls without liver disease (n = 42). Samples were analysed for bactDNA content using quantitative 16S rRNA gene based real time PCR. To define the microbial composition of bactDNA positive samples terminal restriction fragment length polymorphism (T-RFLP) was used and clone library analyses provided the assignment of sequence types to operational taxonomic units (OTU).

Results: All 156 duodenal samples were tested positive for bactDNA with a median of 4.6 × 108 copies/mL (1.0 × 104 – 7.7 × 1010). In total, 19/156 (12.2%) blood samples (cirrhosis 52.6% (n = 10) vs. non-cirrhosis 47.4% (n = 9)) were bactDNA positive (median 5.8 × 103 copies/ml; 1.7 × 103 – 1.5 × 105). T-RFLP analysis of 153/156 (98.1%) duodenal fluids revealed that 90.9% of samples could be assigned to the same microbial community cluster comprising mainly Streptococci and Staphylococci. Correspondingly, cluster analysis of 17/19 (89.5%) blood samples showed just as much agreement (89.5%) in its microbial content. However, intraindividual T-RFLP analysis of patients with bactDNA positive blood samples (n = 17) revealed coincidence of the same cluster profile in only 35.3% (6/17) of sample pairs with 23.4% identical OTU.

Conclusion: The preliminary findings of predominantly different microbial clusters observed in blood and duodenal fluid from patients with cirrhosis emphasize that the duodenum might be an inferior origin for BT.