Periodontal Treatment May Improve Cirrhosis Symptoms

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Routine oral care to treat periodontitis may play a role in reducing inflammation and toxins in the blood (endotoxemia) and improving cognitive function in people with liver cirrhosis, according to researchers at Virginia Commonwealth University.

Cirrhosis, which the researchers call a growing epidemic in the United States, is the presence of scar tissue on the liver. When severe, it can lead to liver failure. Complications include infections throughout the body and hepatic encephalopathy, a buildup of toxins in the brain caused by advanced liver disease. Symptoms of hepatic encephalopathy include confusion, mood changes, and impaired cognitive function.

Previous research shows that people with cirrhosis have changes in gut and salivary microbiota, which can lead to gum disease and a higher risk or cirrhosis-related complications. Also, studies have found that people with cirrhosis have increased levels of inflammation throughout the body, which is associated with hepatic encephalopathy.   

The researchers studied two groups of volunteers who had cirrhosis and mild to moderate periodontitis. One group received periodontal care, including teeth cleaning and removal of bacteria toxins from the teeth and gums. The other group was not treated for gum disease. The researchers collected blood, saliva, and stool samples before and 30 days after treatment. Each volunteer took standardized tests to measure cognitive function before and after treatment.

The treated group, especially those with hepatic encephalopathy, had increased levels of beneficial gut bacteria that could reduce inflammation as well as lower levels of endotoxin-producing bacteria in the saliva when compared to the untreated group. The untreated group, on the other hand, demonstrated an increase in endotoxin levels in the blood over the same time period. 

The improvement in the treated group “could be related to a reduction in oral inflammation leading to lower systemic inflammation or due to [less harmful bacteria] being swallowed and affecting the gut microbiota,” the researchers said in the study.

Cognitive function also improved in the treated group, suggesting that the reduced inflammation levels in the body may minimize some of the symptoms of hepatic encephalopathy in people who are already receiving standard-of-care therapies for the condition. 

This finding is relevant, the researchers said, because there are no further therapies approved by the Food and Drug Administration to alleviate cognition problems in this population, the researchers said. The oral cavity, then, could represent a treatment target for reducing inflammation and endotoxemia in patients who have cirrhosis to improve clinical outcomes, the researchers concluded. 

The study, “Periodontal Therapy Favorably Modulates the Oral-Gut-Hepatic Axis in Cirrhosis,” was published by the American Journal of Physiology-Gastrointestinal and Liver Physiology.

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