Frequency and Factors Associated with Small Intestinal Bacterial Overgrowth in Patients with Cirrhosis of the Liver and Extra Hepatic Portal Venous Obstruction

Abstract

Spontaneous bacterial peritonitis (SBP), a common complication of cirrhosis of liver, might result from translocation of bacteria from the small bowel. However, there is scanty data on frequency of small intestinal bacterial overgrowth (SIBO) in patients with cirrhosis of the liver. There are no data on SIBO in patients with extra-hepatic portal venous obstruction (EHPVO) in the literature. A total of 174 patients with cirrhosis of the liver, 28 with EHPVO and 51 healthy controls were studied for SIBO using glucose hydrogen breath test (GHBT). Persistent rise in breath hydrogen 12 ppm above basal (at least two readings) was considered diagnostic of SIBO. Of 174 patients (age 47.2 +/- 11.9 years, 80.5% male) with cirrhosis due to various causes, 67 (38.5%) were in Child's class A, 70 (40.2%) class B and 37 (21.7%) class C. Of the 174 patients with cirrhosis, 42 (24.14%) had SIBO as compared to 1 of 51 (1.9%) healthy controls (P < 0.0001). Patients with EHPVO had similar frequency of SIBO compared to healthy controls [2/28 (7.14%) vs 1/51 (1.97%), P = ns]. Frequency of SIBO in Child's A, B and C was comparable [13 (18.6%) vs 16 (23.9%) and 13 (35.1%), respectively; P = ns]. Presence of SIBO were not related to ascites, etiology of cirrhosis, and degree of liver dysfunction. SIBO is common in patients with cirrhosis of the liver. Patients with EHPVO do not have higher frequency of SIBO than healthy subjects. SIBO in cirrhosis is not related to the degree of derangement in liver function or of portal hypertension.

Patients With Irritable Bowel Syndrome Exhale More Hydrogen Than Healthy Subjects in Fasting State

“…10% HC and 25% patients with IBS had fasting breath hydrogen value more than 16 ppm in our study. This is in discordance with our previous studies that showed 8.5% to 13% IBS had SIBO compared with 2% HC using glucose hydrogen breath test9,12,23; these data, therefore, further substantiate that fasting breath hydrogen alone should not be used as a criterion for diagnosis of SIBO as reported by some authors previously 24,25. Poor performance of fasting breath hydrogen in diagnosis of SIBO has been shown by Riordan et al22 too.…”

Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO

“…Furthermore, cirrhosis has been noted to be statistically significantly more often in this group of patients [70]. Spontaneous bacterial peritonitis, a frequent complication of cirrhosis, may result from the translocation of bacteria from the small intestine [71]. Studies have demonstrated that obese patients have disturbances of gastrointestinal tract motility, and SIBO often occurs in this group of obese patients [72,73].…”

Gastrointestinal Dysfunction in Chronic Liver Disease

“…In contrast, the transit time of cirrhotic subjects was similar to healthy subjects when magnet based Motility Tracking System [51] and scintigraphic [52] techniques were used. Despite these conflicting findings, manometric studies have consistently demonstrated a number of motor disturbances in the small intestine of these patients, including absence of inter-digestive migratory motor complex (MMC), prolonged duration of MMC cycles and changes in the pattern of contractions with multiple clustered contractions [53][54][55]. As with gastric emptying, there is a relationship between liver disease severity and small intestinal dysmotility [56], and more importantly, these motor abnormalities normalize after liver transplantation [57].…”