Figure 2. Microbiome and hepatic decompensation.

Worsening of liver disease initiates a cascade of events with intestinal bacterial overgrowth and dysbiosis as central events. Intestinal dysbiosis contributes to gut barrier function via several mechanisms. Increases bacterial translocation leads to upregulation of systemic inflammation and infections, vasodilation and contributes to hepatic decompensation and multi organ failure. Toxins produced by the microbiota can directly cause hepatocyte death and worsening of liver function.