Bacterial translocation and amelioration of liver cell damage in response to treatment with propranolol, with or without rifaximin, in patients with cirrhosis and portal hypertension

Measurement of the hepatic venous pressure gradient is performed in patients with cirrhosis to assess for portal hypertension and monitor effectiveness of portal venous pressure-lowering therapies. These include treatment with the non-selective beta-blocker, propranolol, while the broad-spectrum antibiotic, rifaximin, has also been shown to be effective. Whether these treatments to reduce portal venous hypertension in patients with cirrhosis are also associated with reduced bacterial translocation from the intestine and whether reduced bacterial translocation, in turn, results in amelioration of liver dameg are currently unknown. The aim of this study is to meaure markers of bacterial translocation and liver damage in patients with portal venous hypertension complicating cirrhosis who are undergoing hepatic venous pressure gradient measurement at baseline and after four weeks of propranolol therapy. Should the portal venous pressure not be improved satisfactorily after treatment with propranolol alone, then rifaximin will be added and the portal venous pressure and markers of bacterial translocation and liver damage will be reassessed after a further 28 days. Patients intolerant of or with contraindications to propranolol will be studied at baseline and after 28 days of rifaximin monotherapy.