Small intestinal bacterial overgrowth and orocecal transit time in patients of nonalcoholic fatty liver disease

Abstract

Background: To explore the frequency of small intestinal bacterial overgrowth (SIBO) and orocecal transit time (OCTT) in patients with nonalcoholic fatty liver disease (NAFLD). Methods: 103 patients with NAFLD and 49 healthy controls were enrolled. Clinical indicators such as body mass index (BMI), liver function, blood lipids, HOMA-IR, serum endotoxin of NAFLD patients were collected and examined. Fibro Touch was used to detect the (controlled attenuation parameter) CAP and liver stiffness measurement (LSM). SIBO and OCTT were measured by lactulose hydrogen breath test.Results: The incidence of SIBO in NAFLD patients (58.3%) was significantly higher than that in healthy

Prevalence of Small Intestinal Bacterial Overgrowth Syndrome in Patients with Non-Alcoholic Fatty Liver Disease/Non-Alcoholic Steatohepatitis: A Cross-Sectional Study

“…In this context, our results are in line with the results of the study by Guimaraes et al, who reported that the prevalence of SIBO among histologically confirmed NAFLD patients using the lactulose breath test as a diagnostic modality was 26.2% [ 32 ]. Different reports in the literature, both in NAFLD [ 33 , 34 , 35 ] and in NASH [ 36 ] patients that used either cultures of jejunal aspirates [ 33 , 34 , 36 ] or a lactulose breath test [ 35 ] to diagnose SIBO, reported an even higher prevalence of the syndrome, highlighting its frequent occurrence in this population. Specifically, SIBO prevalence was reported to be 40% among NASH individuals [ 36 ], while it approached or exceeded 35% in those with NAFL [ 33 , 34 , 35 ].…”

“…Different reports in the literature, both in NAFLD [ 33 , 34 , 35 ] and in NASH [ 36 ] patients that used either cultures of jejunal aspirates [ 33 , 34 , 36 ] or a lactulose breath test [ 35 ] to diagnose SIBO, reported an even higher prevalence of the syndrome, highlighting its frequent occurrence in this population. Specifically, SIBO prevalence was reported to be 40% among NASH individuals [ 36 ], while it approached or exceeded 35% in those with NAFL [ 33 , 34 , 35 ]. Moreover, among individuals with biopsy-proven NASH, the prevalence of SIBO was >43% both in those with concomitant metabolic syndrome as well as in those without [ 37 ].…”

“…Our study showed that the prevalence of SIBO among patients with NASH-associated cirrhosis was significantly higher compared with patients with NAFL. The relationship between SIBO prevalence and disease stage has been the focus of many studies in this field [ 33 , 34 , 35 , 38 , 40 , 41 , 42 ], with inconclusive results. One of the first studies, that included 136 patients with available liver biopsy who underwent a glucose hydrogen breath test for SIBO detection, demonstrated that SIBO was more frequent among patients with non-severe hepatic steatosis (26.3% vs. 10.3%, p = 0.127), whereas it did not differ in patients with NASH [ 41 ].…”

“…Similar to our results, in a study by Scarpellini et al, a higher prevalence of SIBO, diagnosed using the lactulose breath test, was observed in patients with cirrhosis compared with non-cirrhotic patients (41.2% vs. 13.1%; p < 0.05), but no association was observed between SIBO prevalence and the grade of liver steatosis, as diagnosed using abdominal ultrasound [ 38 ]. On the other hand, a study by Shi et al reported that as the severity of steatosis, expressed as the controlled attenuation parameter, increased, the prevalence of SIBO also increased, ranging from 32.6% to 88% for mild and severe steatosis, respectively [ 35 ]. Additionally, of interest, a recent study by Mikolasevic et al that used jejunal aspirate culture to diagnose SIBO, reported that the prevalence of SIBO was higher among patients with biopsy-proven NASH compared with patients with NAFLD, but provided no evidence of NASH in the liver biopsy (68.1% vs. 29.1%; p < 0.001) [ 33 ].…”

Show Me What You Have Inside—The Complex Interplay between SIBO and Multiple Medical Conditions—A Systematic Review

“…All those factors might be implicated in the development of NAFLD. A high prevalence of SIBO is observed in NAFLD population [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. SIBO, by inducing an immunological fluctuation, could lead to chronic inflammation, mitochondrial disorders, a cumulation of lipids in hepatocytes, and NASH.…”