Association Between Small Intestinal Bacterial Overgrowth and Peripheral Bacterial DNA in Cirrhotic Patients

Jun, Dae Won; Kim, Young Ho; Lee, Oh Young; Chae, Jeong Don; Son, Byoung Kwan; Kim, Seong Hwan; Jo, Yun Ju; Park, Sung Chul

doi:10.1007/s10620-009-0870-9

Cited by 83 publications

(66 citation statements)

References 20 publications

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“…Threemonth mortality was increased in the presence of ascitic bDNA only for patients with a MELD score > 15 [39] . Contrary to hospitalized patients, bDNA was rarely detected in ascitic fluid and serum of asymptomatic [20] , Francés et al [31] , El-Naggar et al [32] , González-Navajas et al [33] , Zapater et al [34] , Jun et al [35] , Fagan et al [36] Cons: Variable rates of detection (maybe depending on methodology used), lower prevalence in outpatients…”

Section: Bacterial Dnamentioning

confidence: 98%

“…The presence of bDNA was also associated with peripheral vasodilation and deterioration of intrahepatic endothelial function [20] . Another study highlighted the strong correlation between SIBO and the presence of bDNA in the peripheral blood of patients with cirrhosis [35] . Moreover, the high bDNA detection frequency was recently confirmed as it was shown that it was detected in ascitic fluid from 23 of 25 patients with culture-negative, non-neutrocytic ascites.…”

Section: Bacterial Dnamentioning

confidence: 99%

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Markers of bacterial translocation in end-stage liver disease

Koutsounas¹,

Kaltsa²,

Siakavellas³

et al. 2015

WJH

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Bacterial translocation (BT) refers to the passage of viable bacteria or bacterial products from the intestinal lumen, through the intestinal epithelium, into the systemic circulation and extraintestinal locations. The three principal mechanisms that are thought to be involved in BT include bacterial overgrowth, disruption of the gut mucosal barrier and an impaired host defence.BT is commonly observed in liver cirrhosis and has been shown to play an important role in the pathogenesis of the complications of end stage liver disease, including infections as well as hepatic encephalopathy and hepatorenal syndrome. Due to the importance of BT in the natural history of cirrhosis, there is intense interest for the discovery of biomarkers of BT. To date, several such candidates have been proposed, which include bacterial DNA, soluble CD14, lipopolysaccharides endotoxin, lipopolysaccharide-binding protein, calprotectin and procalcitonin. Studies on the association of these markers with BT have demonstrated not only promising data but, oftentimes, contradictory results. As a consequence, currently, there is no optimal marker that may be used in clinical practice as a surrogate for the presence of BT.

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Section: Bacterial Dnamentioning

confidence: 98%

Section: Bacterial Dnamentioning

confidence: 99%

Markers of bacterial translocation in end-stage liver disease

Koutsounas¹,

Kaltsa²,

Siakavellas³

et al. 2015

WJH

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“…Gut flora imbalances and higher levels of Enterobacteriaceae resulted in significant changes in BT and liver function in cirrhotic rats [128]. Further, SIBO in cirrhosis showed a high correlation with the presence of bacterial DNA fragments in peripheral blood, suggesting that SIBO could be a major risk factor for BT, especially in ascitic patients [129]. …”

Section: Bacterial Translocationmentioning

confidence: 99%

Changes of Intestinal Functions in Liver Cirrhosis

2016

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Background: Understanding of the gut-liver axis is important for the up-to-date management of liver cirrhosis, and changes of intestinal functions form the core of this interesting research field. Summary: Most investigators noted small intestinal dysmotility in their patients with liver cirrhosis. Marked changes in the contraction pattern were observed in early manometric studies. The orocecal transit time, particularly small intestinal transit, has generally been reported to be prolonged, which has been demonstrated in multiple investigations to be related to the severity of the liver disease (e.g., Child-Pugh class), the presence of small intestinal bacterial overgrowth (SIBO) and hepatic encephalopathy (HE) as well as a history of spontaneous bacterial peritonitis. Bacteriologically proven SIBO in proximal jejunal aspiration has been reported to be present in up to 59% of cirrhotic patients and is associated with systemic endotoxemia. Clinical and experimental studies suggest that delayed small bowel transit in liver cirrhosis may lead to SIBO, which could contribute to the symptoms of abdominal pain and diarrhea. In addition to autonomic neuropathy, metabolic derangements and diabetic state, SIBO itself may delay intestinal transit in cirrhotic patients. Several studies, both from the West and the East, have shown that the gut microbiota is altered in cirrhotic patients and particularly those with HE. Further, a quantitative change in Bacteroides/Firmicutes ratio, with a prevalence of potentially pathogenic bacteria (e.g., Enterobacteriaceae) and reduction in specific commensals (e.g., Lachnospiraceae), has been described. Structural and functional changes in the intestinal mucosa that contribute to increases in intestinal permeability for bacteria and their products have been observed in patients with liver cirrhosis, which is considered as an important pathogenetic factor for several complications. The mechanism of intestinal barrier dysfunction in cirrhosis is multifactorial, including alcohol, portal hypertension (vascular congestion and dysregulation), endotoxemia, SIBO, local inflammation and, most likely, immunological factors and medications. Key Messages: This review summarizes major achievements regarding intestinal dysfunction in cirrhosis for future gastroenterology research. The question of whether this intestinal barrier dysfunction is accompanied and/or at least partly caused by structural and functional changes in the epithelial tight junction proteins is as yet unsolved. Development of new strategies to modulate gut-liver interaction is urgently needed.

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“…Patients with cirrhosis, particularly those with decompensated disease, are at risk of developing serious bacterial infections due to several factors (1,2) ; such as, portal hypertension (3) , immunologic impairment (4) , quantitative and qualitative changes in gut microbiota, intestinal dismotility (5) , small intestinal bacterial overgrowth (6,7) . The gastric acidity is an important host defense barrier; therefore, acid suppression has been associated with adverse events; such as, enteric infections (8,9) , pulmonary infections (10,11) , development of bacterial intestinal overgrowth and bacterial translocation (7) .…”

Section: Introductionmentioning

confidence: 99%

“…The gastric acidity is an important host defense barrier; therefore, acid suppression has been associated with adverse events; such as, enteric infections (8,9) , pulmonary infections (10,11) , development of bacterial intestinal overgrowth and bacterial translocation (7) . Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but at least two studies have reported a high prevalence of patients taking acid-suppressive therapy without a clear indication (12,13) .…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors Increase the Overall Risk of Developing Bacterial Infections in Patients With Cirrhosis

Lázaro-Pacheco

Servín-Caamaño

Pérez-Hernández

et al. 2018

Arq. Gastroenterol.

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-Background -Acid suppression has been associated with adverse events; such as, enteric infections. Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but is unclear if PPI are associated with the development of bacterial infections in these patients. Objective -To assess the impact of PPI intake on the development of bacterial, viral and fungal infections in patients with cirrhosis. Methods -An observational, retrospective, historic cohort study. The exposed cohort included patients with cirrhosis with chronic use of PPI. The non-exposed cohort had not been using PPI. The follow-up period was 3 years, searching in the medical records for any events of bacterial infection confirmed by bacteriological culture. Results -One hundred and thirteen patients met the selection criteria, 44 (39%) had chronic use of PPI; of them, 28 (63.6%) patients had not a clear clinical indication to justify the prescription of PPI. Twenty four (21.2%) patients developed bacterial infections during the follow-up period. In the univariate analysis, decompensated cirrhosis (Child B/C), presence of ascites, history of variceal bleeding, and chronic consumption of PPI were risk factors related to the development of infections. But, in the adjusted multivariate analysis only the chronic use of PPI was associated with development of infections (RR=3.6; 95% CI=1.1-12.3; P=0.04). Conclusion -There is an over-prescription of PPI without a justified clinical indication. The long-term consumption of PPI in patients with cirrhosis is associated with the development of bacterial infections; therefore these drugs must be carefully prescribed in this specific population. HEADINGS -Proton pump inhibitors, adverse effects. Inappropriate prescribing. Liver cirrhosis. Risk assessment.Declared conflict of interest of all authors: Fátima Higuera-de la Tijera has received fees for serving as a speaker for Laboratorios Liomont. The other authors have not conflict of interest to declare. None of the other researchers involved in this study have received fees for serving as a speaker, consultant or as advisory board member for any organization. Disclosure of funding: no funding received

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Association Between Small Intestinal Bacterial Overgrowth and Peripheral Bacterial DNA in Cirrhotic Patients

Abstract: SIBO in cirrhosis patients was observed at a very high frequency, and SIBO showed a high correlation with bacterial translocation, suggesting that SIBO could be a major risk factor of bacterial translocation, especially in ascitic patients.

Cited by 83 publications

References 20 publications

Markers of bacterial translocation in end-stage liver disease

Markers of bacterial translocation in end-stage liver disease

Changes of Intestinal Functions in Liver Cirrhosis

Proton Pump Inhibitors Increase the Overall Risk of Developing Bacterial Infections in Patients With Cirrhosis

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