MASLD can cause halitosis by small intestinal bacterial overgrowth

Area of Science:

• Gastroenterology
• Hepatology
• Metabolic Disorders

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent.
• Patients with MASLD often experience halitosis, suggesting an extra-oral cause.
• Small intestinal bacterial overgrowth (SIBO) is a potential contributor to MASLD and halitosis.

Purpose of the Study:

• To investigate the hypothesis that SIBO contributes to MASLD and subsequent extra-oral halitosis.
• To assess the prevalence of SIBO in patients with MASLD and halitosis.
• To quantify the impact of SIBO on halitosis severity and specific biomarkers.

Main Methods:

• Retrospective cross-sectional study of 885 patients with extra-oral halitosis.
• Diagnosis of MASLD using Fibroscan and cardiometabolic criteria.
• Diagnosis of SIBO via hydrogen breath test.
• Measurement of halitosis using organoleptic score (OLS) and exhaled dimethyl sulfide (DMS) via OralChroma.

Main Results:

• 15.05% of halitosis patients had MASLD; 65.41% of these MASLD patients were SIBO-positive.
• SIBO-positive patients exhibited significantly higher OLS (4 vs 2) and exhaled DMS levels (56 vs 43 ppb) compared to SIBO-negative patients (p < 0.001).
• Exhaled hydrogen levels strongly correlated with OLS and DMS levels (r=0.774, r=0.740; p < 0.001).

Conclusions:

• Small intestinal bacterial overgrowth (SIBO) is a significant factor in halitosis development among patients with MASLD.
• SIBO exacerbates halitosis severity and elevates exhaled dimethyl sulfide levels in MASLD patients.
• Targeting SIBO may be a therapeutic strategy for managing halitosis in MASLD.