Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Liver Cirrhosis

Abstract

AIM: To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and to analyze its relationship with the etiology of the disease and the severity of liver dysfunction in patients with liver cirrhosis (LC). METHODS: Forty-three patients with LC (25 alcohol- and 18 viral-induced) and ten healthy subjects consented to participate in the study. According to Child-Pugh classification, 7 of the patients were with class A, 14 - class В and 22 - class С. SIBO was estimated indirectly by the lactulose hydrogene (H2) breath test. RESULTS: In 4 of the patients no peak of H2 was recorded. In comparison to the control group of healthy subjects, LC patients had significantly higher basal breathed H2 (15.54±10.56 vs 6.24± 3.39 ppm), p<0.05). The mean basal breathed H2 in cirrotic patients with evidence of SIBO was 29.33±6.69 ppm (range 21-42). Of the 39 patients with LC, 12 (31%) had SIBO compared to none of the healthy controls. No differences in SIBO regarding Child-Pugh score were found. SIBO was demonstrated in 45.5% of the alcohol- and only in 11.8% of the viral-induced LC (p<0.05). CONCLUSION: SIBO is common in patients with LC and more frequent in the cases with alcoholic etiology, but it is not related to the severity of liver dysfunction. Future larger trials are needed to establish the exact role of these alterations in patients with LC.