Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease diagnosed by transient elastography and
Ivana Mikolasevic1,2,3, Bozena Delija2, Ana Mijic2
1Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia.
Background:
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non-alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non-significant or no liver fibrosis.
Methods:
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results:
Patients with non-alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07-37.37), 2.50 (1.16-5.37) and 27.6 (6.41-119), respectively). The most commonly isolated were gram-negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae.
Conclusion:
In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well-investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.
Insights
Small intestinal bacterial overgrowth (SIBO) is more common in non-alcoholic fatty liver disease (NAFLD), especially in non-alcoholic steatohepatitis (NASH) and significant fibrosis. Type 2 diabetes mellitus, fibrosis stage, and ballooning grade predict SIBO.
Area of Science:
- Hepatology
- Gastroenterology
- Microbiology
Background:
- Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver conditions.
- Small intestinal bacterial overgrowth (SIBO) is a potential factor in liver disease progression.
Purpose of the Study:
- To investigate the incidence of SIBO in patients with NAFLD.
- To compare SIBO rates in patients with significant fibrosis (SF) versus those without.
Main Methods:
- NAFLD diagnosis using Fibroscan and liver biopsy (LB) in 117 patients.
- SIBO diagnosis via esophagogastroduodenoscopy with duodenal aspirate culture.
Main Results:
- Higher SIBO incidence in non-alcoholic steatohepatitis (NASH) and SF patients compared to controls.
- SIBO group showed increased steatosis, fibrosis, inflammation, and ballooning.
- Type 2 diabetes mellitus (T2DM), fibrosis stage, and ballooning grade independently predicted SIBO.
Conclusions:
- NASH and SF are associated with a higher incidence of SIBO.
- T2DM, fibrosis stage, and ballooning grade are significant predictors of SIBO.
- Histological features of NAFLD, not elastographic parameters, were independent SIBO predictors.
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