Association Between Small Intestinal Bacterial Overgrowth by Glucose Breath Test and Coronary Artery Disease

André, Fabrice; Fialho, Andrea; Kochhar, Gursimran; Schenone, Aldo L.; Thota, Priyaleela; McCullough, Arthur J.; Shen, Bo

doi:10.1007/s10620-017-4828-z

Cited by 19 publications

(15 citation statements)

References 41 publications

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“…Lastly, as Fialho et al [11] recognize, despite the association between SIBO and CAD demonstrated in this paper, no conclusions can be drawn about causality of the relationship. While the work by Ponziani et al linking SIBO and atherosclerosis through the vitamin K-dependent action of MGP suggests a causal relationship, elucidation of an underlying mechanism linking SIBO and CAD is absent in the present study.…”

contrasting

confidence: 70%

“…In the current issue of Digestive Diseases and Sciences, Fialho et al [11] expand upon this work by demonstrating a previously undescribed association between SIBO and coronary artery disease (CAD). In their study, they retrospectively reviewed medical records at a single tertiary care center in order to identify all patients who underwent a glucose hydrogen/methane breath test.…”

mentioning

confidence: 92%

“…Correspondingly, arterial pulse wave velocity, which increases when there is an increase in arterial stiffness, was increased among patients with SIBO compared to that observed in the group without SIBO (10.25 vs 7.68 m/s, p = 0.002). The authors concluded, then, that SIBO is associated with reduced MGP activation as well as arterial stiffening, regarded as important indicators of subclinical atherosclerosis [9].In the current issue of Digestive Diseases and Sciences, Fialho et al [11] expand upon this work by demonstrating a previously undescribed association between SIBO and coronary artery disease (CAD). In their study, they retrospectively reviewed medical records at a single tertiary care center in order to identify all patients who underwent a glucose hydrogen/methane breath test.…”

mentioning

confidence: 97%

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Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs?

Adkins

Rezaie

2018

Dig Dis Sci

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Small intestinal bacterial overgrowth (SIBO) manifests with a variety of gastrointestinal symptoms, including bloating, flatulence, abdominal pain, nausea, dyspepsia, fatigue, diarrhea, and constipation [1]. SIBO has been implicated as a cause of hepatic encephalopathy and of d-lactic acidosis in patients with short bowel syndrome [2,3]. Moreover, SIBO is associated with a variety of conditions outside of the gastrointestinal system, including rosacea [4], restless legs syndrome [5], interstitial cystitis [6], and chronic prostatitis [7], and correlates with the level of somatic pain in fibromyalgia [8]. Along these lines, recent studies have reported a link between SIBO and cardiovascular disease.Ponziani et al. [9] recently published data linking SIBO with subclinical atherosclerosis through the vitamin K-dependent activity of the matrix GIa-protein (MGP), which maintains arterial structure and function through prevention of calcification of vessel walls and the regulation of the extracellular matrix. MGP is carboxylated by the cofactor vitamin K2 to assume its active form. Increased expression of the inactive, uncarboxylated MGP is a marker of low vitamin K2 status, associated with signs of early vascular disease such as arterial stiffness and vascular calcifications, as well as cardiovascular morbidity and mortality. The bulk of vitamin K2 in humans is derived from gut bacterial biosynthesis, and prior studies showed low circulating levels of vitamin K2 in patients with SIBO [10].In their prospective cohort study, 39 patients were included with SIBO suspected on the basis of gastrointestinal symptoms who also had low cardiovascular disease risk and no prior history of cardiovascular events. All patients underwent a glucose breath test, and 12 (39.0%) were diagnosed with SIBO. The median level of inactive MGP was significantly increased among patients with SIBO compared to patients without SIBO (9.5 vs 4.2 µg/L, p = 0.02). Correspondingly, arterial pulse wave velocity, which increases when there is an increase in arterial stiffness, was increased among patients with SIBO compared to that observed in the group without SIBO (10.25 vs 7.68 m/s, p = 0.002). The authors concluded, then, that SIBO is associated with reduced MGP activation as well as arterial stiffening, regarded as important indicators of subclinical atherosclerosis [9].In the current issue of Digestive Diseases and Sciences, Fialho et al. [11] expand upon this work by demonstrating a previously undescribed association between SIBO and coronary artery disease (CAD). In their study, they retrospectively reviewed medical records at a single tertiary care center in order to identify all patients who underwent a glucose hydrogen/methane breath test. Records were crossreferenced to identify 160 patients who had undergone left heart catheterization with coronary angiography at the same center. These records were reviewed to determine the presence and extent of CAD. Importantly, widely recognized risk factors for CAD such as age, smoking, diabetes, hypert...

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confidence: 70%

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confidence: 92%

mentioning

confidence: 97%

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Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs?

Adkins

Rezaie

2018

Dig Dis Sci

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“…There have been studies documenting that the alteration in the number/composition of gut-resident bacteria may be associated with the increased risk of development of CAD. In a retrospective study, the data from 1059 patients revealed that patients with small intestinal bacterial overgrowth had a higher frequency of CAD [22]. A comparative study conducted in CAD patients (n = 39) and healthy volunteers (n = 50) revealed a characteristic change in the gut microbiota.…”

Section: Gut Microbiota Composition and Its Possible Use As A Non-invmentioning

confidence: 99%

Gut microbiota in coronary artery disease: a friend or foe?

et al. 2020

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There is a growing interest in the role of gut microbiota in the pathophysiology of several diseases, including coronary artery diseases (CAD). Gut microorganisms may produce beneficial effects in myocardial ischemia either directly in the form of exogenous administration or indirectly by acting on fiber-rich food to produce important cardioprotective components. The harmful effects of gut microbiota in CAD are due to alteration in their composition with a significant decrease in Bacteroidetes and an increase in Firmicutes, Escherichia, Shigella, and Enterococcus. The altered microbiota may produce potentially toxic metabolites, including trimethylamine-N-oxide (TMAO). Indeed, the fasting plasma levels of TMAO are directly correlated to increased risk of major cardiovascular events in CAD patients, and it is proposed as a potential biomarker to predict the onset of major cardiovascular events. It is concluded that the change in the composition of gut microbiota in CAD patients may predispose to more harmful effects. However, exogenous delivery of probiotics may overcome the detrimental effects of myocardial ischemia.

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“…Так, в недавнем исследовании A. Fialho и соавт. было продемонстрировано, что наличие избыточного бактериального роста в тонкой кишке (СИБР) может служить независимым фактором риска развития ИБС [2]. В 2011 г.…”

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Effect of Rifaximin and a Multi-Strain Probiotic on the Intestinal Microbiome and Cardiovascular Risk Indicators in Patients with Coronary Heart Disease

Кашух

Полуэктова

Кудрявцева

et al. 2019

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim. To assess the effect of rifaximin and a multi-strain probiotic on the intestinal microbiome and the indicators of cardiovascular risk in patients with coronary heart disease (CHD).Materials and methods. A study conducted during the 2016–2019 period included 120 people over 50 years old divided into 3 groups. Group 1 comprised patients with coronary heart disease receiving standard treatment. Group 2 comprised patients with coronary heart disease receiving additionally a probiotic (Bifidobacterium bifidum no less than 1x109 CFU; Bifidobacterium longum no less than 1x109 CFU; Bifidobacterium infantis no less than 1x109 CFU; Lactobacillus rhamnosus no less than 1x109 CFU) within 28 days. Group 3 comprised CHD patients receiving rifaximin for 7 days followed by addition of the multi-strain probiotic under test for 21 days. Group 4 consisted of healthy individuals, comparable in age and sex with the examined CHD patients. In group 4, blood and stool tests were performed once to provide a comparison with group 1. TMAO concentration was determined using liquid chromatography–mass spectrometry. To study the composition of fecal microflora, 16S sequencing was used followed by a graphical representation of the results. The results were analysed using the IBM SPSS 22.0 statistical data processing software.Results. An additional administration of the probiotic (Bifidobacterium bifidum no less than 1x109 CFU; Bifidobacterium longum no less than 1x109 CFU; Bifidobacterium infantis no less than 1x109 CFU; Lactobacillus rhamnosus no less than 1x109 CFU) is found to have no effect on the lipid profile and the platelet aggregation rate. Rifaximin therapy reduced the amount of total cholesterol, low density lipoproteins (LDL), very low density (VLDL) lipoproteins and triglycerides (p <0.05), although not affecting the level of high density lipoproteins (HDL). TMAO showed a statistically insignificant (p>0.05) downward trend in all groups. The composition of the fecal microbiota, at the end of administration of the probiotic, showed an increase in the proportion of bacteria of the Streptococcaceae, Lactobacillaceae, Enterobacteriaceae families and a decrease in the Ruminococcaceae family (p>0.05). After rifaximin therapy, a decrease in the proportion of bacteria of the Clostridiaceae (p <0.05) and Peptostreptococcaceae (p <0.05) families, a decrease in Enterobacteriaceae (p > 0.05) family and a decrease in the Clostridium and Escherichia/Shigella (p > 0.05) genera was observed. The use of the probiotic after a course of treatment with rifaximin did not have a significant effect on the composition of the microflora. In general, the high variability of fecal microbiota between different patients (significantly superior to intergroup differences) does not allow us to draw unambiguous conclusions.Conclusions. The use of a multi-strain probiotic as an additional therapy in patients with coronary heart disease within 28 days did not have a significant effect on lipid metabolism, TMAO level and the composition of fecal microflora. The consecutive use of rifaximin and the probiotic had a beneficial effect on such factors as lipid metabolism (decrease in the level of total cholesterol, LDL, VLDL, triglycerides), but did not affect the concentration of TMAO and the composition of the intestinal microflora in patients with coronary heart disease.

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Association Between Small Intestinal Bacterial Overgrowth by Glucose Breath Test and Coronary Artery Disease

Cited by 19 publications

References 41 publications

Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs?

Small Intestinal Bacterial Overgrowth and Coronary Artery Disease: What Is in the CArDs?

Gut microbiota in coronary artery disease: a friend or foe?

Effect of Rifaximin and a Multi-Strain Probiotic on the Intestinal Microbiome and Cardiovascular Risk Indicators in Patients with Coronary Heart Disease

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