Small Intestinal Bacterial Overgrowth Is Associated with Non- Alcoholic Fatty Liver Disease

2016 ◽  
Vol 25 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Andrea Fialho ◽  
Andre Fialho ◽  
Prashanthi Thota ◽  
Arthur J. McCullough ◽  
Bo Shen
Keyword(s):  
Risk Factors ◽  
Fatty Liver Disease ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Study Group ◽  
Alcoholic Fatty Liver ◽  
Intestinal Bacterial Overgrowth ◽  
Small Intestinal ◽  
Alcoholic Fatty Liver Disease

Background: Changes in gut bacteria play a role in type 2 diabetes mellitus (DM) and hepatic steatosis. There is a lack of studies evaluating the frequency and risk factors for non-alcoholic fatty liver disease (NAFLD) in patients tested for small intestinal bacterial overgrowth (SIBO). Aim: To evaluate the frequency of NAFLD and associated risk factors in patients tested for SIBO. Methods: In this case-control study, 372 eligible patients submitted to glucose hydrogen/methane breath test for SIBO who also had an abdominal imaging study were included. Patients were divided into SIBO-positive and SIBO-negative groups. Clinical, demographic and laboratory variables were evaluated in addition to the presence of NAFLD on abdominal imaging. Results: Of the 372 eligible patients, 141 (37.9%) were tested positive for SIBO (study group) and 231 (62.1%) were negative for it (control group). NAFLD occurred in 45.4% (64/141) of the study group compared to 17.3% (40/231) of the control group (p<0.001). Patients in the study group were found to have higher rates of elevated aspartate aminotransferase (AST) (20.6% vs. 11.3%; p=0.034) and alanine aminotransferase (ALT) levels (56.0% vs. 40.7%; p= 0.039), type 2 diabetes (23.4% vs. 13.9%; p=0.041), hypertension (54.6% vs. 40.3%; p=0.046) and metabolic syndrome (78.0% vs. 60.2%; p=0.020). In the multivariate analysis, SIBO (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.14-3.31; p=0.014), type 2 DM (OR: 3.04; 95%CI: 1.57-5.90; p=0.001) and obesity (OR: 3.58; 95%CI: 1.70-7.54; p=0.001) remained associated with NAFLD.Conclusion: Patients with SIBO have an increased risk for hepatic steatosis and may benefit from aggressive control of the risk factors for NAFLD including metabolic syndrome. Abbreviations: ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; CTE: computed tomography enterography; DM: diabetes mellitus; ETOH: ethanol; IL: interleukin; LPS: lipopolysaccharide; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; PPI: proton pump inhibitor; SIBO: small intestinal bacterial overgrowth; TLR-4: toll-like receptor 4; TMAO: trimethylamine-N-oxide (TMAO); TNF-α: tumor necrosis factor alpha.

scholarly journals Liver disease symptoms in non-alcoholic fatty liver disease and small intestinal bacterial overgrowth

2018 ◽  
Vol 56 (2) ◽  
pp. 85-89
Author(s):  
Rahmatollah Rafiei ◽  
Mahboobeh Bemanian ◽  
Fereshteh Rafiei ◽  
Mahmood Bahrami ◽  
Lotfollah Fooladi ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Alcoholic Fatty Liver ◽  
Intestinal Bacterial Overgrowth ◽  
Significant Difference ◽  
Small Intestinal ◽  
Alcoholic Fatty Liver Disease

Abstract Introduction. It seems that there is a relationship between small intestinal bacterial overgrowth (SIBO) and non-alcoholic fatty liver disease (NAFLD). The main objective of this study was to evaluate the prevalence of SIBO among NAFLD patients. Methods. In this descriptive-analytical cross-sectional study, 98 eligible NAFLD patients were evaluated for SIBO using hydrogen breath test (HBT). They were divided into SIBO-positive and SIBO-negative groups. Demographic, clinical, and laboratory data were obtained. Results. Based on the HBT, 38 patients (39%) had bacteria overgrowth. There were no significant differences between SIBO-positive and SIBO-negative regarding demographic data and BMI classification (P > 0.05). Biochemical variables, the results of abdominal ultrasound, and liver elastography did not show any significant difference between SIBO-positive and SIBO-negative patients (P > 0.05). Patients with SIBO were found to have higher rates of bloating, while abdominal pain was more prevalent in SIBO-negative patients (P < 0.001). Conclusions. SIBO is prevalent in NAFLD and associated with bloating in these patients. Further studies are necessary to elucidate if therapeutic manipulation of gut microbiota reduces the risk of NAFLD, fibrosis, and liver cirrhosis.

scholarly journals THE EFFICACY OF ERADICATION OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

2017 ◽  
Vol 4 ◽  
pp. 34-41
Author(s):  
Sergiy Tkach ◽  
Olena Gubska ◽  
Tetiana Cheverda
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Steatosis ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Steatohepatitis ◽  
Small Intestinal ◽  
Alcoholic Fatty Liver Disease

Background. Emerging evidence suggests a strong interaction between the gut, gut microbiota and liver. Derangement of gut flora, particularly small intestinal bacterial overgrowth (SIBO), occurs in a large percentage of patients with non-alcoholic fatty liver disease (NAFLD) and plays an important role in its pathogenesis. Aim. Study of the frequency of SIBO in various forms of non-alcoholic fatty liver disease, as well as the possibilities of its pathomorphosis as a result of eradication of SIBO as a result of the use of rifaximin or multicomponent probiotic. Material and methods. There were investigated 125 patients with non-alcoholic fatty liver disease (70 men, 55 women aged 18 to 65 years, mean age 37±6.7 years) developed at obesity or type 2 diabetes mellitus, including 85 patients with liver steatosis (group1) and 40 patients with non-alcoholic steatohepatitis (group 2). Patients with concomitant SIBO (70 patients) was treated with rifaximin or multicomponent probiotic. As the main endpoints of the study, the frequency of achieving eradication of SIBO was evaluated (estimated from the results of a repeated H2-lactulose hydrogen test after treatment), as well as a decrease in the severity of liver steatosis by steatometry and a decrease / normalization of transaminase levels 3 months after the start of the treatment. Secondary endpoints included the change in BMI and the HOMA-IR index 3 months after the start of the treatment. Results. SIBO in patients with non-alcoholic fatty liver disease was significantly more frequent than in control (p <0.005), and in patients with non-alcoholic steatohepatitis – significantly more often than in patients with liver steatosis (80 % vs 47.1 %, P <0.01). Eradication of SIBO after use of rifaximin was recorded in 30 of 36 patients with non-alcoholic fatty liver disease (83.3 %), including 16 of 20 patients with steatosis (80 %) and 14 of 16 (87.5 %) patients with non-alcoholic steatohepatitis. In the group of patients taking multicomponent probiotics after treatment, eradication of SIBO was noted in 12 of 36 patients (33.3 %), including 7 patients with steatosis (35 %) and 5 patients (31.3 %) with non-alcoholic steatohepatitis Conclusion. The investigation shows that the eradication of small intestinal bacterial overgrowth has the positive influence on the natural course of NAFLD and use of rifaximine should be discussed as a perspective therapeutic strategy at this pathology

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