Association between small intestinal bacterial overgrowth and deep vein thrombosis

Abstract

Objective: Small intestinal bacterial overgrowth (SIBO) has been associated with several diseases. The association between SIBO and deep vein thrombosis (DVT) has not been investigated. This study was aimed to investigate the frequency and risk factors for the development of DVT in patients tested for SIBO.Methods: All 321 eligible patients were included from the Cleveland Clinic Gastrointestinal Motility Lab databank from January 2008 to January 2014. Patients who were evaluated with glucose hydrogen/methane breath test as well as Doppler ultrasonography for suspected DVT were included. Patients with catheter-related DVT were excluded. The primary outcomes were the frequency and risk factors (including SIBO) for DVT in this patient population.Results: Of the 321-case cohort, 144 patients (44.9%) tested positive for SIBO, and 53 (16.5%) had ultrasonographic findings of DVT. SIBO evaluation before the evaluation of DVT occurred in 201 patients (median time from the breath test to ultrasonography: 27 months; interquartile range [IQR]: 11.0–45.0 months), and SIBO evaluation after evaluation for DVT occurred in 120 patients (median time from ultrasonography to the breath test: 30 months; IQR: 11.8–54.3 months). In the univariate analysis, DVT was associated with family history of thromboembolic events (35.8% vs 16.0%, P=0.001), chronic kidney diseases (CKD; 26.4% vs 13.4%, P=0.019) and the presence of SIBO (69.8% vs 39.9%, P<0.001). In the multivariate analysis, family history of thromboembolic events (odds ratio [OR]: 3.39; 95% confidence interval [CI]: 1.67–6.87; P<0.001), CKD (OR: 2.23; 95%CI: 1.04–4.74; P = 0.037), and the presence of SIBO (OR: 3.27; 95% CI: 1.70–6.32; P < 0.001) remained independently associated with DVT.Conclusion: SIBO was found to be associated with DVT. The nature of this association warrants further investigation.

Association between small‐intestinal bacterial overgrowth and deep vein thrombosis in patients with spinal cord injuries

“…We found that the presence of SIBO (OR 3.72; 95% CI 1.97-6.62; P < 0.001) remained associated with DVT when evaluated in the multivariate model. Consistent with our results, Fialho et al [12] suggested that SIBO was associated with DVT as an independent risk factor along with CKD and a family history of thromboembolic events in first-degree relatives.…”

“…Consistent with our results, Fialho et al . suggested that SIBO was associated with DVT as an independent risk factor along with CKD and a family history of thromboembolic events in first‐degree relatives.…”

“…above the basal value, or hydrogen and/or methane increase of 412 p.p.m. between the minimum and maximum values after glucose ingestion [12,14].…”

“…Furthermore, bowel problems occur in 27-62% of SCI patients, and are often associated with depression or with the highest levels of injuries and the longest duration [11]. Interestingly, Fialho et al [12] found that SIBO was associated with DVT in patients who were identified from the databank of the GI Motility Laboratory at the Cleveland Clinic. However, there are no published studies in the literature evaluating a possible role of quantitative changes in intestinal bacteria such as SIBO and the development of DVT in SCI patients.…”

Resolution of Deep Venous Thrombosis: Proposed Immune Paradigms

“…As early as 1952, fibrin was shown to be an effective physical barrier against foreign particles [51]. DVT can be initiated by damage to the endothelial cells lining the vein wall [52] at the site of a potential infection, as well as with lipopolysaccharide endotoxemia from Gram-negative bacteremia [53], and even with colonization of the small bowel with Gram-negative bacteria [54]. Thus, thrombus represents an effective response to sepsis both because it has the potential to envelop and contain the point source of an infection, and also because it is the concentrated precipitate of filters that remove pathogens from blood [55].…”