Small bowel bacterial overgrowth in patients with alcoholic cirrhosis

Abstract

A total of 89 patients with alcoholic cirrhosis and 40 healthy subjects were included in a study to assess the prevalence of intestinal bacterial overgrowth and to analyze its relationship with the severity of liver dysfunction, presence of ascites, and development of spontaneous bacterial peritonitis (SBP). Bacterial overgrowth was measured by means of a breath test after ingestion of glucose. Intestinal bacterial overgrowth was documented in 27 (30.3%) of the 89 patients with alcoholic cirrhosis and in none of the healthy subjects. The prevalence of intestinal bacterial overgrowth was significantly higher in cirrhotics with ascites (37.1%) than in those with no evidence of ascites (5.3%) and among patients with Pugh-Child class C (48.3%) than in patients with a class A (13.1%) or B (27%). Twelve (17.1%) of the 70 patients with ascites developed an episode of SBP. The prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth (30.7%) than in patients who did not (9.09%). We conclude that intestinal bacterial overgrowth occurs in approximately one third of patients with cirrhosis secondary to alcohol, particularly in patients with ascites and advanced liver dysfunction. Moreover, bacterial overgrowth may be a condition favoring infection of the ascitic fluid.

Host-Microbiome Interactions in Alcoholic Liver Disease

“…The number of both anaerobic and aerobic bacteria was significantly higher in jejunal aspirates from patients with chronic alcohol abuse as compared with control subjects 6. Similar results were obtained in patients with alcoholic cirrhosis 7. Moreover, the degree of overgrowth correlates with the severity of cirrhosis 8.…”

Nitric oxide and the hyperdynamic circulation in cirrhosis: is there a role for selective intestinal decontamination?

“…Furthermore, administration of conjugated oral bile acids to ascitic cirrhotic animals increased bile acid secretion, eliminated intestinal bacterial overgrowth, decreased bacterial translocation and endotoxaemia and increased survival [38]. Translating these findings to the clinical setting, Casafont Morencos et al [39] demonstrated that 30 % of alcoholic cirrhotic patients had intestinal bacterial overgrowth on the basis of breath testing compared with none in the healthy controls and, moreover, the prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth than in patients who did not. It has also been demonstrated [40] that the incidence of bacterial overgrowth of the small intestine was much higher in cirrhotic patients with bacterial peritonitis than in those without spontaneous bacterial peritonitis.…”

Novel prevention strategies for bacterial infections in cirrhosis

“…Bacterial overgrowth of the small intestine may occur in certain disease states, and is defined as at least 10 5 total CFU/mL in jejunal secretions. Small intestinal bacterial overgrowth is prominent in both cirrhotic rats with ascites and patients with cirrhosis [24-27], and is thought to be the most common site of bacterial translocation [28]. It is related to the severity of liver disease [27], and increases the risk of bacterial translocation and infection [24, 29, 30].…”

“…Small intestinal bacterial overgrowth is prominent in both cirrhotic rats with ascites and patients with cirrhosis [24-27], and is thought to be the most common site of bacterial translocation [28]. It is related to the severity of liver disease [27], and increases the risk of bacterial translocation and infection [24, 29, 30]. Proposed strategies to target this bacterial overgrowth involve decreasing the overall bacterial burden or changing the taxonomy of intestinal microbes to favor the growth of anaerobic bacteria [Figure 3].…”