The effect of small intestinal bacterial overgrowth on minimal hepatic encephalopathy in patients with cirrhosis

Abstract

IntroductionThe aim of the study was to investigate the significance of factors associated with minimal hepatic encephalopathy (MHE) in cirrhotic patients.Material and methodsBetween September 2012 and August 2013, 60 cirrhotic patients, including MHE and non-MHE (NMHE) patients, were included in the study. Associated factors and clinical factors were analyzed to see if they were significantly different between MHE and non-MHE patients. Upon identifying the factors showing differences, we applied multivariate regression analysis to further decide which were the most significant ones to differentiate MHE from NMHE patients.ResultsThere were 26 patients diagnosed with MHE and 34 with NMHE. Our results demonstrated that the prevalence rate of small intestinal bacterial overgrowth (SIBO) was highly associated with patients with MHE (65.4%, 17 out of 26), in contrast to the rate in NMHE patients (8.8%, 3 out of 34). We also found that factors including age, education level, intelligent test results, plasma albumin level and plasma ammonia levels were significantly different between MHE and NMHE patients. Ultimately, with logistic regression analysis, we found that SIBO was the most significant factor differentiating MHE patients from NMHE patients (p < 0.05).ConclusionsIn cirrhotic patients, SIBO was highly associated with MHE. This may further our understanding of the mechanisms of MHE and help to develop potential therapeutic interventions to treat cirrhotic patients with MHE.

Microbiome and bile acid profiles in duodenal aspirates from patients with liver cirrhosis: The Microbiome, Microbial Markers and Liver Disease Study

“…We also observed differences in the duodenal microbiome according to the presence of HE, which is typically a late complication of cirrhosis. Although prior studies have shown that small intestinal bacterial overgrowth is associated with HE, we additionally found that patients with HE also have lower microbial richness and diversity in the duodenum compared to patients without HE . Potentially related to this observation are prior reports that have linked lower diversity of the fecal microbiome to cirrhosis severity .…”

Gut Microbiota Modulation and Fecal Transplantation: An Overview on Innovative Strategies for Hepatic Encephalopathy Treatment

“…As described earlier, SIBO is commonly associated with cirrhosis, affecting up to 59% of these patients [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. The gold standard diagnostic method is a demonstration of greater than 10 5 colony forming units per millimeter in the proximal jejunum via aspiration during endoscopic examination.…”

“…SIBO typically shows an over-abundance of gram-negative bacteria including Escherichia coli and Klebsiella pneumoniae [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. These organisms are linked to the development of decompensated cirrhosis and the development of HE due to their ability to translocate [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. One meta-analysis demonstrated that the prevalence of SIBO in cirrhosis is significantly greater than its prevalence in otherwise healthy individuals [ 58 ].…”

Liver Cirrhosis and Sarcopenia from the Viewpoint of Dysbiosis

“…Increased intestinal permeability may help bacteria move into the systemic circulation. SIBO has been implicated as an important risk factor in the etiology of both SBP and HE in LC patients [ 102 , 103 ]. Thus, SIBO is deeply involved in the progression of CLD, which may be linked to sarcopenia [ 102 , 103 ].…”