Ciprofloxacin suppresses bacterial overgrowth, increases fasting insulin but does not correct low acylated ghrelin concentration in non‐alcoholic steatohepatitis

Abstract

SUMMARYBackground: Insulin resistance and oxidative stress induced by products of small intestinal bacterial activity are putative factors in the pathogenesis of non-alcoholic steatohepatitis. Acylated ghrelin is the biologically active form of an orexigenic gastric hormone that modifies insulin sensitivity and body composition. Aim: To investigate the effect of ciprofloxacin on small intestinal bacterial activity, ethanol, ghrelin and insulin in non-alcoholic steatohepatitis patients. Methods: Twelve non-alcoholic steatohepatitis patients and 11 controls were studied before and after ciprofloxacin 500 mg b.d. for 5 days. After an overnight fast, 75 g glucose was ingested and blood was sampled every 20 min for 120 min. Acylated and total ghrelin, ethanol and insulin were measured. Small intestinal bacterial activity was detected by glucose hydrogen breath test. Results: Mean (range) integrated plasma acylated ghrelin which was 102 (21-241) and 202 (88-366) pg/ mL AE 2 h in non-alcoholic steatohepatitis and controls

Small Intestinal Bacterial Overgrowth in Nonalcoholic Steatohepatitis: Association with Toll-Like Receptor 4 Expression and Plasma Levels of Interleukin 8

“…They found that 50% of NASH patients had a positive breath test in comparison with only 22% of their healthy controls. In other studies, the occurrence of SIBO in NAFLD/NASH has been documented using either the lactulose [10] or glucose breath test [73]. Recently, the presence of SIBO has been associated with the severity of liver steatosis [17].…”

High Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Morbid Obesity: A Contributor to Severe Hepatic Steatosis

“…Descriptions of fatty degeneration have been reported in morbidly obese patients with jejuno-ileal bypass [8,9] and in small bowel diverticulosis [10], both conditions favouring bacterial overgrowth. Wigg et al [11] and Sajjad et al [12] showed that the prevalence of SIBO assessed by (14) C-D-xylose and lactulose or glucose breath tests was higher in patients with NASH compared with control subjects. However, in patients with morbid obesity, the prevalence of SIBO is unknown and its role in liver injuries has not been studied before.…”

Ghrelin in Pathological Conditions

“…In a study, low ghrelin serum levels were found in NAFLD patients [137] while in another study it was demonstrated that low ghrelin levels could not be attributed to small intestinal bacterial activity [139], which is encountered commonly in non-alcoholic steatohepatitis. In addition, ghrelin levels were significantly correlated with Homeostasis Model Assessment index (HOMA-IR ) in both healthy and NAFLD patients [137].…”