Understanding the Gut-Liver-Brain Connection: Cirrhosis and Its Effects on the Brain
VCU gastroenterologist Jasmohan Bajaj, M.D., and colleague Mark Pimentel, M.D., of the MAST Center and Cedars-Sinai Medical Center, address the question, “Is Hepatic Encephalopathy the First True Disorder of Gut-Brain Interaction?” in the American Journal of Gastroenterology.
Cirrhosis is a serious condition where the liver becomes damaged and scarred over time. This damage is caused by long-term inflammation, degeneration and scarring of liver tissue. It’s not just a problem for the liver — it’s the leading cause of liver failure and the reason many people need liver transplants.
But cirrhosis doesn’t just affect the liver. It can also increase the risk of brain and mood disorders. One common issue is a cognitive condition called hepatic encephalopathy (HE). HE happens when the liver can’t remove harmful toxins from the blood, which then build up and affect the brain. This can lead to problems with thinking, memory, and coordination.
People with cirrhosis are also at a higher risk of developing serious brain diseases like Alzheimer’s and Parkinson’s. They may experience mood disorders such as anxiety and depression, which can make their daily lives even harder.
The gut-liver-brain connection
In recent years, scientists such as Bajaj, also of the Richmond VA Medical Center, have discovered something important: the liver, gut, and brain are all connected. They constantly send signals to one another, affecting how each organ works. This connection is called the "gut-liver-brain axis."
One key player in this system is the gut microbiome. This is the community of bacteria and other tiny organisms that live in your digestive system. When someone has cirrhosis, the balance of these gut bacteria can get disrupted—a condition called gut dysbiosis.
Studies in both humans and animals show that gut dysbiosis can worsen cirrhosis and contribute to problems with the brain, like memory loss, confusion, and mood swings. This is true whether or not alcohol use is involved.
So, is hepatic encephalopathy the first true disorder of the gut-brain interaction? Bajaj emphatically says yes.
Hope for treatment
The good news is that researchers are exploring ways to treat cirrhosis by focusing on the gut. By restoring a healthy balance in the gut microbiome, it might be possible to improve liver health and reduce brain and mood problems.
Treatments could include probiotics, dietary changes, or even new medications designed to target gut bacteria.
What this means for you
Cirrhosis is a complex condition that affects more than just the liver. Understanding the gut-liver-brain connection could lead to better treatments and improved quality of life for people living with this disease. If you or a loved one has cirrhosis, talk to your doctor about managing not only liver health but also mental and emotional well-being.