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Stephen Malnick

1Division of Gastroenterology, Kaplan Health Sciences Centre, Rehovot, Israel
2Department of Medicine, Faculty of Medicine, Hebrew University, Rehovot, Israel

Alcoholic liver disease is one of the commonest cause of cirrhosis in Western countries, with significant morbidity and mortality. There is a central role of metabolic products of alcohol.
The fecal microbiome is now recognised as having a critical role in the development of many disease processes and also produces endogenous alcohol via the fermentation of carbohydrates. The intestinal metabolism of alcohol produces acetaldehyde that affects gut permeability. Alcohol also produces a change in the composition of gut microbiota, including an increase in gram-negative bacteria.
Translocation of bacterial products into the portal blood results in endotoxemia and immune system activation, including Toll-like receptors-4 (TLR-4) which are present on Kupfer cells.
Alterations in gut microbiota, metabolic changes in a dysbiotic intestinal environment and host factors are all critical contributors to the development and progression of alcoholic liver disease. The modification of the intestinal microbiota by antibiotics, probiotics and synbiotics may improve alcoholic liver disease.