BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease worldwide. Approximately 20% of individuals with NAFLD develop nonalcoholic steatohepatitis (NASH), which is associated with increased risk of cirrhosis, portal hypertension, and hepatocellular carcinoma. Intestinal microflora, including small intestinal bacterial overgrowth (SIBO), appear to play an important role in the pathogenesis of the disease, as demonstrated in several clinical and experimental studies, by altering intestinal permeability and allowing bacterial endotoxins to enter the circulation. OBJECTIVE: To determine the relationship between SIBO and endotoxin serum levels with clinical, laboratory, and histopathological aspects of NAFLD and the relationship between SIBO and endotoxin serum levels before and after antibiotic therapy. METHODS: Adult patients with a histological diagnosis of NAFLD, without cirrhosis were included. A comprehensive biochemistry panel, lactulose breath test (for diagnosis of SIBO), and serum endotoxin measurement (chromogenic LAL assay) were performed. SIBO was treated with metronidazole 250 mg q8h for 10 days and refractory cases were given ciprofloxacin 500 mg q12h for 10 days. RESULTS: Overall, 42 patients with a histopathological diagnosis of NAFLD were examined. The prevalence of SIBO was 26.2%. Comparison of demographic and biochemical parameters between patients with SIBO and those without SIBO revealed no statistically significant differences, except for use of proton pump inhibitors, which was significantly more frequent in patients with positive breath testing. The presence of SIBO was also associated with greater severity of hepatocellular ballooning on liver biopsy. Although the sample, as a whole, have elevated circulating endotoxin levels, we found no significant differences in this parameter between the groups with and without SIBO. Endotoxin values before and after antibiotic treatment did not differ, even on paired analysis, suggesting absence of any relationship between these factors. Serum endotoxin levels were inversely correlated with HDL levels, and directly correlated with triglyceride levels. CONCLUSION: Serum endotoxin levels did not differ between patients with and without SIBO, nor did these levels change after antibacterial therapy, virtually ruling out the possibility that elevated endotoxinemia in non-cirrhotic patients with NAFLD is associated with SIBO. Presence of SIBO was associated with greater severity of ballooning degeneration on liver biopsy, but not with a significantly higher prevalence of NASH. Additional studies are needed to evaluate the reproducibility and importance of this finding in patients with NAFLD and SIBO.

AIM: In patients with chronic hepatitis C virus (HCV) infection, 25-hydroxyvitamin D3 [25(OH)D] deficiency has been associated with disease progression and decreased odds of sustained virologic response (SVR) to pegylated interferon and ribavirin combination therapy (PegIFN + RBV). METHODS: In this retrospective study, the pretreatment 25(OH) D levels of patients with genotype 1 HCV infection treated with PegIFN + RBV for 48 weeks were measured and correlated with disease stage and periportal necroinflammatory activity (PPA) on liver biopsy, as well as to virologic response at the end of the treatment period. Serum 25(OH)D levels were quantitated by chemiluminescence. RESULTS: Of the 201 patients included, 53% were male and 70% were white, with a mean (SD) age of 46 (± 11) years. Subtype 1b was identified in 48% of cases, and 57% of patients had a viral load over 800 000 IU/mL. Overall, 29% of patients had stage 3/4 fibrosis and 40% had grade 3/4 PPA. SVR was achieved in 47% of patients. The mean 25(OH)D concentration was 26.3 (± 11.5) ng/mL. Low 25(OH)D levels (< 30 ng/dL) were detected in 69% of patients, and were not associated with staging (rS =-0.003; P = 0.895) or grading (rS = 0.045; P = 0.105). There were no significant differences in SVR rate between patients with vs those without 25(OH)D deficiency (49% vs 40%, P = 0.359). The only variables associated with 25(OH)D insufficiency or deficiency were serum albumin (rS = 0.199; P = 0.006), female sex (rS = 0.249; P = 0.002), and age (rS =-0.227; P = 0.001). CONCLUSION: In this sample of patients with chronic HCV infection, vitamin D deficiency was not associated with increased histologic severity, nor with increased likelihood of SVR.

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