Bacterial overgrowth in the small intestine (SIBO) is a pathological growth of the intestinal microbiota in the small intestine that causes clinical symptoms and can lead to digestive and absorption disorders. There is increasing evidence that people with NAFLD have a distinct gut microflora profile as well metabolome changes compared to people without NAFLD. Thorough analysis of observational and RCT studies in the current databases (EMBASE, Web of Science, PubMed, Cinahl, Clinical Trials) was conducted from 3 November 2021 to 21 June 2022. The following inclusion criteria were applied: confirmed NAFLD, NASH, LIVER FIBROSIS, CIRRHOSIS due to steatosis; diagnostic methods of liver diseases—biopsy, elastography, transabdominal ultrasound; nonalcoholic fatty liver disease activity score; confirmed SIBO; diagnostic methods of SIBO–breath tests (hydrogen test; methane test and mix test; duodenal and jejunal aspiration before any type of intervention; adults above 18yo; number of participants ≥20; full articles. We excluded review articles, populations with HBV/HCV infection and alcohol etiology and interventions that may affect NAFLD or SIBO treatment. The quality of each study methodology was classified by means of the Cochrane Collaboration’s tool (RCT) and Newcastle—Ottawa Quality Assessment Scale adapted for cross-sectional, cohort and case-control studies. The random effects meta-analysis of outcomes for which ≥2 studies contributed data was conducted. The I2 index to measure heterogeneity and the ꭓ2 test of homogeneity (statistically significant heterogeneity p < 0.05) were applied. For categorical outcome, the pooled event rate (effect size) was calculated. This systematic review was reported according to PRISMA reporting guidelines. We initially identified 6643 studies, from which 18 studies were included in final meta-analysis. The total number of patients was 1263. Accepted SIBO diagnostic methods were both available breath tests (n-total = 15) and aspirate culture (n-total = 3). We found that among patients with non-alcoholic liver diseases, the random overall event rate of SIBO was 0.350 (95%CI, 0.244–0.472), p = 0.017. The subgroup analysis regarding a type of diagnosis revealed that the lowest ER was among patients who developed simultaneously NAFLD, NASH and fibrosis: 0.197 (95% CI, 0.054–0.510) as compared to other annotated subgroups. The highest prevalence of SIBO was observed in the NASH subgroup: 0.411 (95% CI, 0.219–0.634). There were no statistically significant differences in the prevalence of SIBO in different subgroups (p = 0.854). Statistically significant heterogeneity between studies was estimated (I2 = 86.17%, p = 0.00). Egger’s test did not indicate a publication bias (df = 16, p = 0.885). A meta-regression using a random-effects model revealed that higher percentage of males in the population with liver diseases is a predisposing factor toward SIBO (Q = 4.11, df = 1, p = 0.0426 with coefficient = 0.0195, SE = 0.0096, Z = 2.03). We showed that the prevalence of SIBO in patients with chronic non-alcoholic liver diseases can be as high as 35%, and it increases with the percentage of men in the population. The prevalence of SIBO does not differ significantly depending on the type of chronic liver disease. Despite the high heterogeneity and moderate and low quality of included studies, our meta-analysis suggests the existence of a problem of SIBO in the population of patients with non-alcoholic liver diseases, and the presence of SIBO, in turn, determines the therapeutic treatment of such type of patients, which indicates the need for further research in this area. The study protocol was registered with the international Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022341473).
Background & Aims: Functional gastrointestinal disorders are prevalent worldwide and alterations of gutbrain axis and intestinal barrier integrity may play a pivotal role in both the pathophysiology and clinical course of these bowel malfunctions. We aimed to assess the prevalence of abdominal pain in a selected adult population of Poland to determine potential environmental factors associated with gastrointestinal complaints.Methods: There were 1479 individuals – 657 women (44.42%) and 822 men (55.58%), aged 24.20±6.08 years. The responders fulfilled an authors’ questionnaire based on Rome II and III criteria focused on the abdominal pain prevalence and environmental factors involved in its occurrence.Results: The frequency of abdominal pain was found to be as high as 19.2%. Male gender (n=822) and basic education level (n=151) lowered the risk of abdominal pain occurrence (OR=0.7, p<0.012 and OR=0.5, p<0.021, respectively). Psychological distress, proton pump inhibitors (PPIs) and antibiotics usage were found as risk factors of abdominal pain (OR=2.503, p<0.01; OR=3.308, p<0.01; OR=3.105, p<0.01, respectively).Conclusions: Abdominal pain is prevalent in young adult inhabitants of Poland, especially in women. Intense psychological stress, as well as PPIs and antibiotics usage elevate the risk.
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with the pathological accumulation of lipids inside hepatocytes. Untreated NAFL can progress to non-alcoholic hepatitis (NASH), followed by fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The common denominator of the above-mentioned metabolic disorders seems to be insulin resistance, which occurs in NAFLD patients. Obesity is the greatest risk factor for lipid accumulation inside hepatocytes, but a part of the NAFLD patient population has a normal body weight according to the BMI index. Obese people with or without NAFLD have a higher incidence of small intestinal bacterial overgrowth (SIBO), and those suffering from NAFLD show increased intestinal permeability, including a more frequent presence of bacterial overgrowth in the small intestine (SIBO). The health consequences of SIBO are primarily malabsorption disorders (vitamin B12, iron, choline, fats, carbohydrates and proteins) and bile salt deconjugation. Undetected and untreated SIBO may lead to nutrient and/or energy malnutrition, thus directly impairing liver function (e.g., folic acid and choline deficiency). However, whether SIBO contributes to liver dysfunction, decreased intestinal barrier integrity, increased inflammation, endotoxemia and bacterial translocation is not yet clear. In this review, we focus on gut–liver axis and discuss critical points, novel insights and the role of nutrition, lifestyle, pre- and probiotics, medication and supplements in the therapy and prevention of both SIBO and NAFLD.
Alterations of gut microbiota, intestinal barrier and the gut-brain axis may be involved in pathophysiology of functional gastrointestinal disorders. Our aim was to assess the prevalence of digestive tract symptoms and identify common variables potentially disrupting the gut-brain axis among participants of the Woodstock Festival Poland, 2017. In total 428 people filled in a questionnaire assessing health of their digestive tract. The investigator collected answers on an electronic device, while the study participant responded using a paper version of the same questionnaire. Liver and gallbladder related symptoms were the most prevalent among our study group (n = 266, 62%), however symptoms related to altered intestinal permeability were found to be the most intensive complaints. In females the intensity of gastrointestinal complaints was higher compared to men (p < 0.05), as well as the incidence of factors with the potential to alter gut-brain axis (p < 0.0001). Chronic psychological distress, intake of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, were the most common associations with gastrointestinal symptoms, which were the most prevalent in females. Further attention should be focused on stress as one of the main factors negatively influencing public health.
Background. The ketogenic diet (KD) has been used for almost 100 years in the treatment of drug-resistant epilepsy in children - and adults. The intestinal microbiome has a climax character, and the main factor changing its composition and functions is the diet. Both increased biodiversity and the production of short-chain fatty acids (SCFAs) are important indicators of gut barrier function. SCFAs are synthesized by microorganisms through the fermentation of dietary fibre provided with the diet. They are an important element in signal transduction from the digestive system to other tissues. To date, there is little research to determine how the use of KD alters the SCFAs profile of the human stool. Objective. To assess the SCFAs profile in the stool of healthy and active KD users. Material and methods. Study group: amateur athletes following KD. Control group: amateur athletes following a regular diet (carbohydrates min. 50%); gender: men and women aged 18-60. Material: stool sample (1x10 g). SCFAs content was determined in stool samples using gas chromtography method. Participants completed a Food Frequency Questionnaire (FFQ) and a 72-hour food diary. Results. There research has shown differences in the amount of SCFAs, as far as the results obtained from the two groups are concerned. The discrepancies referred to the levels of acetic, butyric, iso-butyric, valeric, and isovaleric acids. Spearman's rank correlation analysis showed a strong relationship between the consumption of selected dietary components (vegetables, fruits, red meat, poultry, fish, nuts and seeds, sugar, sugar substitutes, fats) and the SCFAs content in the stool of the study group. Conclusions. High consumption of cruciferous and leaf vegetables, berries and nuts on a ketogenic diet may have a positive effect on the profile of short-chain fatty acids produced by the gut microbiome. Changing the diet towards a greater supply of plant products may prevent proteolytic fermentation and reduce the negative effects of microbiome changes caused by an oversupply of protein and fat in the ketogenic diet.
Background: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder (FGID), in which etiology and pathogenesis are not fully explored. There is an ongoing need for more population studies adhering to new ROME IV criteria. In the current study, which follows our previous investigation among participants of the Woodstock Rock Festival in Poland, we aimed to evaluate the prevalence of IBS and its relation to age, gender, education, and IBS type. Methods: Rome IV criteria questionnaire was used to assess abdominal complaints of 386 participants of the Woodstock Rock festival 2018. Results: Analyzed data revealed that Rome IV criteria were met by 42 participants (11.41%), 11 men and 31 women (p = 0.0028), with following types of IBS: IBS-M (mixed form) 55%, IBS-D (with diarrhea) 33%, IBS-U (unclassified) 10%, IBS-C (with constipation) 2%. No statistically significant correlation between IBS prevalence and age, gender, or education (p > 0.05) was found. Conclusions: The prevalence of IBS among major rock festival participants in Poland was high. Women met the criteria more often than men, which is consistent with global epidemiology for many years. Among participants of the Woodstock Rock Festival, the most frequent subtype was IBS-M, the rarest—IBS-C. There is a need of conducting cohort studies in bigger groups in our population.
One of the most important functional parts of a human intestinal tract is the microscopic intestinal barrier. Its function is to ensure the correct nutrient absorption and to protect against multiple pathogens, xenobiotics, and environmental toxins. Intestinal microbiota is an integral part of the intestinal epithelium. Human microbiota and their host interact with each other, both directly and indirectly, via multiple intermediates and metabolites. Some dietary fat that is not fully digested reaches the distal parts of the intestinal tract, where an interaction with gut microbiota takes place. Studies have shown that an animal-product based diet that provides a greater supply of saturated fat increases the number of bile-resistant microorganisms, including Bilophila. The total amount of Alistipes and Bacteroides is also increased. Long-term consumption of animal-based foods contributes to the formation of the enterotype described as the Bacteroides type. The ketogenic diet is mainly based on animal fats. The changes induced by this higher consumption of animal fats are associated with unfavorable metabolic changes. However, more and more research has shown evidence of the therapeutic properties of a ketogenic diet as far as neurodegenerative and metabolic diseases are concerned. Recent reports suggest that the protective effect of a ketogenic diet is highly dependent on the gut microbiota. This review focuses on the correlation between the influence of ketogenic diet on the intestinal microbiota changes observed while analyzing patients with diseases such as epilepsy, Alzheimer's disease, autism spectrum disorder, and multiple sclerosis.
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