Intestinal barrier dysfunction, characterized by increased permeability and elevated bacterial translocation, is frequently observed in patients with liver cirrhosis, particularly those with portal hypertension, and is associated with endotoxemia and the development of spontaneous bacterial peritonitis and hepatic encephalopathy.

High pressure in the blood vessels around the gut causes fluid to leak into the gut wall, stretching and damaging the tight seals between gut cells. This lets bacteria and their toxins escape into the bloodstream. At the same time, slow movement of food through the intestines lets bacteria multiply in the wrong places. These bacteria release more toxins, which further damage the gut lining. The liver, already damaged, cannot filter out these toxins, so they spread throughout the body, triggering inflammation that harms the brain and other organs.