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[Bacterial overgrowth in small intestine in patients with liver cirrhosis]
J Chesta1, M Silva, L Thompson
1Centro de Gastroenterología, Hospital Clínico, Santiago de Chile.
Abstract:
Hepatic encephalopathy, bacterial infections and endotoxemia in cirrhotic patients have been related to colonic flora. However, an abnormal small bowel bacterial content could also be implied. We investigated small bowel bacterial overgrowth (SIBO) by jejunal cultures in 14 cirrhotic patients and 5 control subjects, and indirectly by the lactulose H2 breath test in 22 patients with cirrhosis and 12 controls. SIBO was demonstrated by cultures in 64% of cirrhotic patients and 1 of 5 controls. The breath test was positive for SIBO in 45% of patients with cirrhosis and 8% of controls. No differences were noted between patients with alcoholic and non-alcoholic liver disease. According to fasting H2 breath levels, SIBO was significantly correlated with the Child-Pugh score for hepatic function (r = 0.45; p < 0.05). Also, patients with positive criteria for SIBO in jejunal cultures had worse hepatic function in comparison to cirrhotics with normal jejunal bacterial counts (p < 0.05). Thus SIBO is frequent in patients with hepatic cirrhosis and is associated with impairment in hepatic function.
Insights
Small intestinal bacterial overgrowth (SIBO) is common in cirrhosis patients, affecting liver function. This study found SIBO in a majority of patients, correlating with poorer hepatic function.
Area of Science:
- Gastroenterology
- Hepatology
- Microbiology
Background:
- Colonic flora alterations are linked to complications in cirrhosis.
- The role of small bowel bacterial overgrowth (SIBO) in cirrhosis remains less understood.
- Investigating SIBO offers potential insights into cirrhosis pathogenesis.
Purpose of the Study:
- To determine the prevalence of SIBO in cirrhotic patients.
- To assess the relationship between SIBO and the severity of liver disease.
- To compare SIBO detection methods in cirrhosis.
Main Methods:
- Jejunal cultures were performed on 14 cirrhotic patients and 5 controls.
- Lactulose H2 breath tests were used to indirectly assess SIBO in 22 cirrhotic patients and 12 controls.
- Correlation analysis was used to link SIBO with the Child-Pugh score.
Main Results:
- SIBO was confirmed by jejunal cultures in 64% of cirrhotic patients versus 20% of controls.
- The lactulose H2 breath test indicated SIBO in 45% of cirrhotic patients versus 8% of controls.
- SIBO prevalence did not differ between alcoholic and non-alcoholic liver disease patients.
- Fasting H2 breath levels showed a significant correlation between SIBO and the Child-Pugh score (r = 0.45; p < 0.05).
- Patients with SIBO on jejunal culture exhibited worse hepatic function.
Conclusions:
- Small intestinal bacterial overgrowth (SIBO) is highly prevalent in patients with hepatic cirrhosis.
- SIBO is significantly associated with impaired hepatic function in cirrhosis.
- These findings suggest SIBO as a contributing factor to disease severity in cirrhosis.