A recent review published in the World Journal of Pediatric Surgery highlights the gut microbiome's critical role in biliary atresia (BA), the leading cause of liver transplantation in children. The review synthesizes evidence showing that infants with BA have a distinct gut microbial imbalance, with overgrowth of harmful bacteria like Streptococcus and Enterococcus and depletion of beneficial microbes such as Bifidobacterium. These disturbances are present before corrective surgery and are associated with worse outcomes, including failure to clear jaundice and faster disease progression.
BA affects approximately one in 10,000 to 15,000 infants worldwide. The standard treatment, Kasai portoenterostomy, aims to restore bile flow but succeeds in only about 60% of cases. Even with surgery, many children progress to liver failure by early adulthood. The review, conducted by Dr. Vandana Jain, examines microbial composition before and after the Kasai procedure, identifying consistent dysbiosis patterns that persist post-surgery. Factors like reduced breastfeeding and routine use of broad-spectrum antibiotics further disrupt the microbiome.
The gut-liver axis is central to BA pathogenesis, with microbial metabolites like short-chain fatty acids playing protective roles. Butyrate, for instance, has shown anti-fibrotic effects in experimental models. Disruptions in bile acid metabolism by gut bacteria create a vicious cycle of liver injury and microbial imbalance. The authors note that the microbiome is modifiable, opening avenues for new therapies such as probiotics, prebiotics, or fecal microbiota transplantation. Early studies with Lactobacillus rhamnosus GG have shown mixed results, emphasizing the need for careful strain selection and timing.
The review also calls for reevaluating current practices, like prophylactic antibiotics after Kasai surgery, which may harm the developing microbiome. By integrating microbiome science into clinical care, researchers hope to improve native liver survival and reduce the need for transplantation. The findings underscore the urgent need for further research into how the gut-liver-microbiota axis influences BA.
For more details, see the original study: https://doi.org/10.1136/wjps-2025-001068
