The role of Small Intestinal Bacterial Overgrowth (SIBO) in Non-alcoholic Fatty Liver Disease (NAFLD) patients evaluated using Controlled Attenuation Parameter (CAP) Transient Elastography (TE): a tertiary referral center experience

Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is an emerging disease, where it can progress to non-alcoholic steatohepatitis (NASH) and lead to liver cirrhosis or liver cancer. Small intestinal bacterial overgrowth (SIBO) has been hypothesized to play an important role in NAFLD development and progression, however, there is still conflicting data about this phenomenon. Transient Elastography (TE) examination using controlled attenuation parameter (CAP) has been validated for liver disease progression assessment in NAFLD. It is non-invasive method and easy to perform in clinical practice. Therefore, we would like to know the role of SIBO in NAFLD and its possible impact on disease progression.MethodsA cross-sectional design study performed at outpatient’s Hepatobiliary clinic at tertiary referral university hospital in Jakarta. All recruited study subjects based on inclusions criteria underwent laboratory examination, transabdominal ultrasound examination, CAP-TE 502 (by Echosens, France), and glucose hydrogen breath test (GHBT) using portable hydrogen breath test apparatus (Gastro+™ Gastrolyzer by Bedfont Scientific Ltd). Stool sample examination was performed using RT-PCR.ResultsThis study recruited 160 subjects with median age of 58 (22–78) years and 108 (67.5%) of them are female. SIBO (65,5%), DM (70.8%), dyslipidemia (75.2%), obesity (76.6%), and metabolic syndrome (73%) were more prevalent in NAFLD than non-NAFLD population. Bivariate analysis showed no significant association between SIBO and NAFLD development (p = 0.191; PR 0.871; CI 95% [0.306–1.269]). SIBO was also not associated with significant hepatic steatosis (p = 0.951; PR = 0.951; CI 95% [0.452–2.239]) and fibrosis (p = 0.371; PR = 1.369; CI 95% [0.608–3.772]). However, the presence of central obesity has significantly associated with the presence of SIBO (p = 0.001; PR = 0.378; CI 95% [0.021–0.478]). Based on stool sample analysis from 60 NAFLD patients, there is a significant correlation using Spearmen test between the presence of Bacteroides and the stage of fibrosis (p .037). Further analysis between obese NAFLD patients and non-obese NAFLD patients showing that there is a significant decrease of Bifidobacteria (p .047) and Lactobacillus (p .038) in obese NAFLD patients and a tendency of increase Bacteroides in obese NAFLD patients (p .572).ConclusionsSIBO is not associated with NAFLD development and progression.

Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy

“…10,21,22,[24][25][26]28 We included patients only with both FibroScan and LB diagnosed NAFLD in our analysis. In a part of the previous studies, NASH was diagnosed via non-invasive methods (US abdomen, liver enzymes and transient elastography), 10,22,23 while in other studies, NASH was diagnosed solely based on LB. 21,[24][25][26] According to recent studies, TE is a suitable method for non-invasive detection and staging of steatosis and fibrosis.…”

Targeting the GPR119/incretin axis: a promising new therapy for metabolic-associated fatty liver disease

“…Cohen et al used bioinformatics to find that the part encoded by the N -acyl amide gene of human symbiotic bacteria interacts with GPR119 by mimicking human lipid signaling molecules, such as 2-OG, showing a way to treat metabolic diseases thought to regulate intestinal microbes [ 110 ]. Fitriakusumah et al found that MAFLD is significantly associated with the overgrowth of intestinal flora [ 111 ]. The overgrowth of intestinal flora in MAFLD patients can cause changes in the permeability of the intestinal mucosa and the destruction of tight junction structures, resulting in lipopolysaccharides (LPS) and other substances entering the blood, and they interact with Toll-like receptors through NF-kB and other pathways, producing inflammatory mediators and triggering chronic inflammation and insulin resistance (IR) [ 112 , 113 ].…”

Plausible Biological Interactions of Low- and Non-Calorie Sweeteners with the Intestinal Microbiota: An Update of Recent Studies

“…Polyols are around 25%-100% as sweet as sugar and include erythritol, hydrogenated starch hydrolysates (sometimes listed as maltitol syrup, hydrogenated glucose syrup, polyglycitol, polyglucitol, or simply HSH), isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. All of them are considered safe for human consumption as long as they are consumed within the acceptable daily intake [6]. This safety was claimed by the European Food Safety Authority (EFSA) except for cyclamate, which is not approved by the US Food and Drug Administration [1,7,8].…”