The Lancet Gastroenterology & Hepatology Journal Cover June 1st 2017

The intestinal microbiome has been the intense focus of recent study, but how the microbiota affects connected organs such as the liver has not been fully elucidated. The microbiome regulates intestinal permeability and helps metabolize the human diet into small molecules, directly affecting liver health. Several studies have linked intestinal dysbiosis to the severity and progression of liver disease such as NAFLD/NASH, PSC, TPN- and CF-associated liver disease. However, there is limited information and interpretation in regards to how the microbiome may contribute to liver disease in the pediatric population. Notably, the gut microbiota is uniquely distinct at birth and does not establish an adult profile until the 3rd year of life. Clinical research suggests that pediatric liver disease differs in both severity and rate of progression as compared to adult forms, suggesting independent mechanisms of pathogenesis. Here, we discuss current data linking the intestinal microbiome to liver disease development and therapeutic efforts to modify the microbiome in children.