Jasmohan S. Bajaj
SAN FRANCISCO — Periodontal therapy in patients with cirrhosis correlated with improved oral and gut dysbiosis, systemic inflammation, MELD score, cognition and 90-day hospitalizations, according to data presented at The Liver Meeting 2018.
“Prior studies have shown that patients with cirrhosis have very poor dentition, either because of local issues with immunity and low salivary production, and many patients with cirrhosis do unfortunately continue to drink and smoke, which causes a lot of issues with their dental and gum disease,” Jasmohan S. Bajaj, from the Virginia Commonwealth University, told Healio Gastroenterology and Liver Disease.
To explore the relationship between oral cavity disease and the gut-liver axis, Bajaj and colleagues enrolled and matched 24 patients with cirrhosis and 21 patients without cirrhosis who had chronic gingivitis and mild to moderate periodontitis.
The researchers sequenced saliva and stool samples for microbial composition and serum for MELD score, endotoxin and inflammatory cytokines at baseline and 30 days after patients underwent periodontal therapy. Patients also underwent cognitive and quality-of-life assessments.
After 90 days of follow-up, patients with cirrhosis demonstrated reduced serum endotoxin and both salivary and serum inflammatory cytokines, had significantly lower MELD scores, and a lower prevalence for 90-day hospitalizations (P < .05).
Endotoxemia and MELD decreased among patients with prior hepatic encephalopathy and statistically matched pre-therapy levels of patients without hepatic encephalopathy. Patients with hepatic encephalopathy also demonstrated improved cognition and quality of life scores (P < .05).
“We assumed for a long time that the gut is the only source of endotoxin, but we found saliva was also a source,” Bajaj said.
Regarding microbiota, the researchers found a significant difference in beta-diversity at baseline and at day 30 between patients with cirrhosis and hepatic encephalopathy, those with cirrhosis without hepatic encephalopathy, and the controls (P < .05).
“We found that patients who did not have anything done over 30 days had increases in their serum endotoxin levels, which is what you’d expect as time goes by in patients with cirrhosis, whereas the people who had their teeth cleaned ... had improved dysbiosis in their saliva and stool,” Bajaj said. “In addition, patients felt better. These are very simple things that we can do to make our patients’ lives potentially better and reduce sources of inflammation.” – by Talitha Bennett
Bajaj JS, et al. Abstract 2039. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.
Disclosure: Bajaj reports no relevant financial disclosures.