Alterations in the Gut Microbiota of Cirrhosis Patients with Sarcopenia and PH after TIPS

Background however, its impact on the gut microbiota and muscle condition remains unclear. Therefore, this prospective study aimed to evaluate gut microbiota alterations in patients with sarcopenia and PH following TIPS treatment. Methods: Gut microbiota analysis was prospectively conducted in 20 cirrhosis patients with sarcopenia and PH receiving TIPS and their first-degree healthy family between December 2019 and July 2021 in our center. Fecal samples were collected before and 3 months after TIPS and analyzed by 16S rRNA sequencing. Microbial diversity and composition were assessed using standard bioinformatic pipelines. Sarcopenia was defined by L3 skeletal muscle index according to EASL criteria. Results: Compared with healthy controls, cirrhosis patients with sarcopenia and PH exhibited significantly reduced α-diversity (Chao1, Shannon, Simpson; all p < 0. 001) and distinct β-diversity clustering, confirming gut dysbiosis. Although TIPS did not significantly alter overall α-diversity, a significant increase in the order Burkholderiales and a reduction in Pseudomonadales and Staphylococcales were detected after TIPS. Analysis of the family taxonomic rank revealed that TIPS was followed by an increase in a greater abundance of Ruminococcaceae and Sutterellaceae and decreased levels of Tannerellaceae, Marinifilaceae and Pseudomonadaceae. At the genus level, after TIPS placement, increased levels of LachnospiraceaeND3007group, Intestinibacter, Fusicatenibacter, and Faecalibacterium and lower abundances of Pseudomonas, Prevotella, Peptostreptococcus, Parabacteroides, Muribaculaceae, and Butyricimonas were detected. Sarcopenia reversal was observed in 25% of patients, characterized by enrichment of SCFA-producing genera such as Faecalibacterium and Streptococcus, whereas patients without improvement showed high abundance of Fusicatenibacter and low levels of beneficial taxa. Conclusion: TIPS induces significant taxonomic shifts without changing overall diversity in cirrhosis patients with sarcopenia and PH, suggesting partial microbial restoration. Enrichment of SCFA-producing bacteria may correlates with improved sarcopenia, whereas pro-inflammatory taxa may indicate poor recovery and higher risk of complications. These findings highlight the gut–muscle–liver axis and support microbiome-based biomarkers and interventions to optimize outcomes after TIPS.