Alcoholic liver disease (ALD) accounts for the major causes of cirrhosis and liver-related death globally. Researchers on alcoholic liver disease have shown increased levels of bacterial endotoxin in the portal circulation, signifying a role for gut-derived toxins in ALD. Alcohol consumption tends to breach the intestinal epithelial barrier and cause increased gut permeability which is indeed a key factor in ALD. 

Bacterial endotoxin is a lipopolysaccharide and a prototypic microbe-derived inflammatory signal that activates Toll-like receptor 4, which initiates inflammation in ALD. 

Current evidence proves the association of alcohol consumption with alterations in the gut microbiome. This intestinal microbiome imbalance of pathogenic and commensal organisms may provoke an abnormal gut–liver axis in ALD. Bacterial decontamination has shown ALD improvement both in human and animal models. 

SOURCE- Szabo G. Gut–Liver Axis in Alcoholic Liver Disease, Gastroenterology,2015; 148(1): 30-36. https://doi.org/10.1053/j.gastro.2014.10.042.