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Small bowel bacterial overgrowth and endotoxemia in cirrhosis
Jinhui Wang1, Minhu Chen, Guangyu Sun
1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University of Medical Sciences, Guangzhou 510080, China.
Objective:
To investigate the incidence of the small bowel bacterial overgrowth in cirrhotics and analyze the correlation among small bowel bacterial overgrowth (SBBO), plasma endotoxin level and plasma interleukin-2(IL-2), interleukin-6(IL-6), or tumor necrosis factor alpha(TNF-alpha) level.
Methods:
Small bowel bacterial overgrowth in 71 cirrhotics was test by glucose hydrogen breath test (GHBT); plasma endotoxin in cirrhotics was measured with limilus lysate test; and plasma cytokine (IL-2, IL-6 and TNF-alpha) was measured with a solid-phase enzyme-linked immunosorbent assay; the incidence of SBBO in those 71 cirrhotics was investigated and the correlation between plasma endotoxin level and plasma IL-2, IL-6, or TNF-alpha level was analysed.
Results:
(1)Positive GHBT were observed in 18 of 71 icrrhotics(25.3%); (2) Plasma endotoxin, IL-2, IL-6 and TNF-alpha levels were significantly higher in those cirrhotic patients with positive GHBT than in those with negative GHBT [(0.715 +/- 0.229) Eu/L versus (0.379 +/- 0.223) Eu/L, (19.15 +/- 4.60) ng/L versus (9.41 +/- 6.69) ng/L, (93.29 +/- 27.37) ng/L versus (53.22 +/- 28.31) ng/L, (42.18 +/- 16.91) ng/L versus (27.72 +/- 17.06) ng/L, respectively; P < 0.01]; (3) A significant correlation was observed between the level of plasma endotoxin and the level of plasma IL-2(r = 0.894, P < 0.001), IL-6(r = 0.857, P < 0.001) or TNF-alpha( r = 0.845,P < 0.001)in cirrhotics;
Conclusions:
(1)Plasma endotoxin, IL-2, IL-6,and TNF-alpha levels are increased in cirrhotic patients with SBBO, which suggests SBBO in cirrhotics may exasperated endotoxeamia;(2)Plasma endotoxin level in cirrhotics may stimulate some kinds of immune activated cells to produce IL-2, IL-6 and TNF-alpha, which may deteriorated cirrhosis or the complications.
Insights
Small bowel bacterial overgrowth (SBBO) affects 25.3% of cirrhotics. Elevated plasma endotoxin, IL-2, IL-6, and TNF-alpha levels in SBBO patients suggest a link between bacterial overgrowth and cirrhosis complications.
Area of Science:
- Gastroenterology
- Hepatology
- Microbiology
Background:
- Cirrhosis is associated with altered gut microbiota.
- Small bowel bacterial overgrowth (SBBO) is a potential complication in cirrhosis.
- Endotoxemia and elevated cytokines are implicated in cirrhosis progression.
Purpose of the Study:
- To determine the incidence of SBBO in cirrhotic patients.
- To analyze the correlation between SBBO, plasma endotoxin, and inflammatory cytokines (IL-2, IL-6, TNF-alpha).
Main Methods:
- 71 cirrhotic patients underwent glucose hydrogen breath test (GHBT) for SBBO detection.
- Plasma endotoxin levels were measured using the Limulus lysate test.
- Plasma levels of IL-2, IL-6, and TNF-alpha were quantified via ELISA.
Main Results:
- SBBO was detected in 18 of 71 cirrhotics (25.3%).
- Patients with SBBO exhibited significantly higher plasma endotoxin, IL-2, IL-6, and TNF-alpha levels compared to those without SBBO (P < 0.01).
- Strong positive correlations were found between plasma endotoxin and IL-2 (r=0.894), IL-6 (r=0.857), and TNF-alpha (r=0.845) levels (P < 0.001).
Conclusions:
- SBBO is prevalent in cirrhosis and may contribute to endotoxemia.
- Elevated plasma endotoxin in cirrhotics may trigger cytokine production, potentially worsening cirrhosis and its complications.
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