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Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis
C S Chang1, G H Chen, H C Lien
1Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Abstract:
Patients with bacterial overgrowth of the small intestine developed spontaneous bacterial peritonitis (SBP) more frequently than patients without bacterial overgrowth of the small intestine. The objective of this study was to determine whether the incidences of small intestine dysmotility and bacterial overgrowth are higher in cirrhotic patients with a history of SBP than in cirrhotic patients without SBP. Forty cirrhotic patients were enrolled in this study. There were 20 patients with a history of SBP and 20 patients without a history of SBP. Small intestine bacterial overgrowth was diagnosed by breath hydrogen test. Small intestine motility was recorded, by a 3-channel solid-state manometric catheter, for 24 hours. There were no statistical differences in age or sex between the two groups. The Child-Pugh scores in the SBP group were higher than in the non-SBP group (10.5 +/- 2.1 vs. 8.1 +/- 1.9, P < .01). The incidence of bacterial overgrowth of the small intestine was higher in the SBP group than in the non-SBP group (70% vs. 20%, P < .01). The amplitude and duration of migrating motor complex (MMC) activity fronts, as well as the number of clusters per hour, were similar in both groups. However, the frequency of MMC activity fronts was higher in the non-SBP group than in the SBP group (4.8 +/- 2.3/24 hours vs. 3.5 +/- 1.2/24 hours, P < .05). In addition, the MMC velocity was significantly higher in the non-SBP group (8.3 +/- 2.6 vs. 5.3 +/- 2.1 cm/min, P < .01). The incidence of bacterial overgrowth of the small intestine was higher in cirrhotic patients with history of SBP than in those without SBP. Small intestine motility dysfunction was more severe in cirrhotic patients with history of SBP. Impaired motility of the small intestine, causing bacterial overgrowth of the small intestine, may be one of the explanations for recurrent SBP in cirrhotic patients.
Insights
Cirrhotic patients with a history of spontaneous bacterial peritonitis (SBP) have higher rates of small intestine bacterial overgrowth and impaired motility. This suggests motility dysfunction may contribute to recurrent SBP in these patients.
Area of Science:
- Gastroenterology
- Hepatology
- Microbiology
Background:
- Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients.
- Bacterial overgrowth of the small intestine is linked to increased SBP incidence.
- The relationship between SBP history, small intestine dysmotility, and bacterial overgrowth in cirrhosis requires further investigation.
Purpose of the Study:
- To investigate whether cirrhotic patients with a history of SBP exhibit higher incidences of small intestine dysmotility and bacterial overgrowth compared to those without SBP.
- To explore the potential role of impaired small intestine motility in recurrent SBP.
Main Methods:
- A comparative study involving 40 cirrhotic patients, divided into two groups: 20 with a history of SBP and 20 without.
- Diagnosis of small intestine bacterial overgrowth using the breath hydrogen test.
- 24-hour recording of small intestine motility using a 3-channel solid-state manometric catheter to assess migrating motor complex (MMC) parameters.
Main Results:
- Patients with a history of SBP had significantly higher Child-Pugh scores.
- The incidence of small intestine bacterial overgrowth was significantly higher in the SBP group (70%) compared to the non-SBP group (20%).
- While MMC amplitude and duration were similar, the frequency and velocity of MMC activity fronts were significantly reduced in the SBP group, indicating impaired motility.
Conclusions:
- Cirrhotic patients with a history of SBP demonstrate a higher prevalence of small intestine bacterial overgrowth.
- Small intestine motility dysfunction is more pronounced in cirrhotic patients with a history of SBP.
- Impaired small intestine motility leading to bacterial overgrowth may be a key factor in the recurrence of SBP in cirrhotic individuals.