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Additionally, they produce short-chain fatty acids (SCFAs) such as butyrate, which protect the gut lining by promoting epithelial integrity and reducing inflammation.139 However, individuals with ALD show a reduction in SCFAs, which correlates with impaired gut barrier function.137 139 Alcohol-induced dysbiosis, characterised by an imbalance in the microbial community, also results in a decrease in microbial metabolites called indoles.140 This decrease contributes to lower levels of IL-22, an essential cytokine for maintaining gut integrity.140 The reduction in IL-22 weakens the gut barrier, facilitating bacterial translocation into the liver and contributing to the progression of ALD.141 Alcohol consumption has been shown to reduce bacterial diversity and alter the abundance of various bacterial taxa in mice.142144 Studies involving alcohol administration in animal models have demonstrated a decrease in the abundance of the Lactobacillus, Bacteroidetes and Firmicutes phyla.142144 Conversely, there is an observed increase in the Proteobacteria and Actinobacteria phyla, as well as in Verrucomicrobia, Enterobacteria and Enterococcus.142144 Similar dysbiotic patterns have been noted in human studies

Bioorg Med Chem 26(10):27002707

In some patients, lifestyle changes such as reducing protein intake and increasing dietary fiber may be necessary