Evaluating the gut-liver axis using a novel gas sensing capsult in cirrhosis and portal hypertension

The burden of chronic liver disease (CLD) continues to rise in Australia. The clinical consequences of advanced CLD occur almost exclusively in the setting of cirrhosis and portal hypertension. Pronounced physiological disturbances including neurohormonal alterations, immune dysfunction, coagulation dysregulation, as well as gut dysbiosis and bacterial translocation leading to systemic inflammation are all contributors to this process. Similarly, intestinal dysmotility worsens between compensated and decompensated liver cirrhosis states. The gut-liver axis is thus an area of considerable interest as a driver of liver disease progression. We aim to study and compare differences in intestinal motility and intestinal gas profiles amongst patients with compensated and decompensated liver cirrhosis with portal hypertension using a gas sensing capsule (Atmo Biosciences). The following will occur as part of data collection: (1) Clinical assessment (2) 3-Day Food diary (3) Transient liver elastography (Fibroscan) (4) Peripheral blood collection (frozen as plasma and serum samples) (5) Atmo gas sensing capsule ingestion. Participants will return home with the Atmo Data Receiver and be instructed to remain nil by mouth for 6 hours. The Atmo Data Receiver will be returned once the capsule is passed in the stool. Data collection will occur during a single study visit which is approximated to last for 1-1.5 hours with the following breakdown: 30mins (clinical assessment), 10 mins (pathology collection), 15 mins (Fibroscan assessment) and 10 mins (capsule ingestion and connection). There will be no further follow up (one time data collection).