{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:14:10Z","timestamp":1789704850823,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T00:00:00Z","timestamp":1507680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Veterans Affairs Merit Review","award":["1I0CX10076"],"award-info":[{"award-number":["1I0CX10076"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Alcoholism Clin &amp;amp; Exp Res"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cirrhosis and alcohol can independently affect the gut\u2013liver axis with systemic inflammation. However, their concurrent impact in humans is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our aim was to determine the effect of continued alcohol misuse on the gut\u2010liver axis in cirrhotic patients. Age\u2010 and <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content>\u2010balanced cirrhotic patients who were currently drinking (Alc) or abstinent (<jats:styled-content style=\"fixed-case\">NA<\/jats:styled-content>lc) and healthy controls underwent serum and stool collection. A subset underwent upper endoscopy and colonoscopy for biopsies and duodenal fluid collection. The groups were compared regarding (i) <jats:italic>inflammation\/intestinal barrier<\/jats:italic>: systemic <jats:styled-content style=\"fixed-case\">tumor necrosis factor<\/jats:styled-content> levels, intestinal inflammatory cytokine (duodenum, ileum, sigmoid), and ileal antimicrobial peptide expression; (ii) <jats:italic>microbiota composition<\/jats:italic>: 16Sr<jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> sequencing of duodenal, ileal, and colonic mucosal and fecal microbiota; and (iii) <jats:italic>microbial functionality<\/jats:italic>: duodenal fluid and fecal bile acid (<jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content>) profile (conjugation and dehydroxylation status), intestinal <jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content> transporter (<jats:styled-content style=\"fixed-case\">ASBT<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> FXR<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> FGF<\/jats:styled-content>\u201019, <jats:styled-content style=\"fixed-case\">SHP<\/jats:styled-content>) expression, and stool metabolomics using gas chromatography\/mass spectrometry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Alc patients demonstrated a significant duodenal, ileal, and colonic mucosal and fecal dysbiosis, compared to <jats:styled-content style=\"fixed-case\">NA<\/jats:styled-content>lc and controls with lower autochthonous bacterial taxa. <jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content> profile skewed toward a potentially toxic profile (higher secondary and glycine\u2010conjugated <jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content>s) in duodenal fluid and stool in Alc patients. Duodenal fluid demonstrated conjugated secondary <jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content>s only in the Alc group. There was a greater expression of all ileal <jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content> transporters in Alc patients. This group also showed higher endotoxemia, systemic and ileal inflammatory expression, and lower amino acid and bioenergetic\u2010associated metabolites, without change in antimicrobial peptide expression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite cirrhosis, continued alcohol misuse predisposes patients to widespread dysbiosis with alterations in microbial functionality such as a toxic BA profile, which can lead to intestinal and systemic inflammation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.13498","type":"journal-article","created":{"date-parts":[[2017,9,19]],"date-time":"2017-09-19T07:48:39Z","timestamp":1505807319000},"page":"1857-1865","source":"Crossref","is-referenced-by-count":111,"title":["Continued Alcohol Misuse in Human Cirrhosis is Associated with an Impaired Gut\u2013Liver Axis"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan 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