High Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Morbid Obesity: a Contributor to Severe Hepatic Steatosis

Overview

Journal Obes Surg

Date 2008 Feb 21

PMID 18286348

Citations 91

Authors

Jean-Marc Sabate

Pauline Jouet

Florence Harnois

Charlotte Mechler

Simon Msika

Maggy Grossin

Benoit Coffin

Affiliations

Soon will be listed here.

Abstract

Background: With the increasing prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) has become a major cause of liver diseases. Small intestinal bacterial overgrowth (SIBO) could be related to NAFLD. Our aim was to determine the prevalence of SIBO and its relationship with liver lesions in morbidly obese patients.

Methods: A glucose hydrogen (H(2)) breath test (positive if fasting breath H(2) concentration > 20 ppm and/or an increase of > 10 ppm over baseline within the first 2 h) was performed in obese patients referred for bariatric surgery (body mass index [BMI] > 40 kg/m(2) or > 35 in association with comorbidities) and in healthy non-obese subjects. In obese patients, a surgical liver biopsy was performed.

Results: One hundred and forty-six patients (129 women, age [mean+/-SE]: 40.7 +/- 11.4 years) were prospectively included in the study. The mean BMI was 46.1+/-6.4 kg/m(2). A liver biopsy was available in 137 patients and a breath test in 136. The frequency of positive breath tests was higher in obese patients (24/136, 17.1%) than in healthy subjects (1/40, 2.5%; P=0.031). In the univariate analysis, SIBO was not associated with clinical variables, but tended to be associated with more frequent severe hepatic steatosis (26.3 vs. 10.3%, P=0.127), whereas the frequency of sinusoidal or portal fibrosis, lobular necrosis and non-alcoholic steatohepatitis (NASH) were not different. In the multivariate analysis, SIBO (P=0.005) and the presence of a metabolic syndrome (P=0.006) were independent factors of severe hepatic steatosis.

Conclusion: In morbidly obese patients, bacterial overgrowth prevalence is higher than in healthy subjects and is associated with severe hepatic steatosis.

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References

Machado M, Marques-Vidal P, Cortez-Pinto H . Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006; 45(4):600-6. DOI: 10.1016/j.jhep.2006.06.013. View

Yang S, Lin H, Lane M, Clemens M, Diehl A . Obesity increases sensitivity to endotoxin liver injury: implications for the pathogenesis of steatohepatitis. Proc Natl Acad Sci U S A. 1997; 94(6):2557-62. PMC: 20127. DOI: 10.1073/pnas.94.6.2557. View

Casafont Morencos F, de las Heras Castano G, Martin Ramos L, Lopez Arias M, Ledesma F, Romero F . Small bowel bacterial overgrowth in patients with alcoholic cirrhosis. Dig Dis Sci. 1996; 41(3):552-6. DOI: 10.1007/BF02282340. View

Bauer T, Schwacha H, Steinbruckner B, Brinkmann F, Ditzen A, Kist M . Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: poor performance of the glucose breath hydrogen test. J Hepatol. 2000; 33(3):382-6. DOI: 10.1016/s0168-8278(00)80273-1. View

Li Z, Yang S, Lin H, Huang J, Watkins P, Moser A . Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepatology. 2003; 37(2):343-50. DOI: 10.1053/jhep.2003.50048. View

Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P . Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002; 123(1):134-40. DOI: 10.1053/gast.2002.34168. View

Sajjad A, Mottershead M, Syn W, Jones R, Smith S, Nwokolo C . Ciprofloxacin suppresses bacterial overgrowth, increases fasting insulin but does not correct low acylated ghrelin concentration in non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2005; 22(4):291-9. DOI: 10.1111/j.1365-2036.2005.02562.x. View

Merriman R, Ferrell L, Patti M, Weston S, Pabst M, Aouizerat B . Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease. Hepatology. 2006; 44(4):874-80. DOI: 10.1002/hep.21346. View

Suter M, Dorta G, Giusti V, Calmes J . Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004; 14(7):959-66. DOI: 10.1381/0960892041719581. View

10.

Cani P, Neyrinck A, Fava F, Knauf C, Burcelin R, Tuohy K . Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia. Diabetologia. 2007; 50(11):2374-83. DOI: 10.1007/s00125-007-0791-0. View

11.

Chang C, Chen G, Lien H, Yeh H . Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 1998; 28(5):1187-90. DOI: 10.1002/hep.510280504. View

12.

Lichtman S, Okoruwa E, Keku J, Schwab J, Sartor R . Degradation of endogenous bacterial cell wall polymers by the muralytic enzyme mutanolysin prevents hepatobiliary injury in genetically susceptible rats with experimental intestinal bacterial overgrowth. J Clin Invest. 1992; 90(4):1313-22. PMC: 443175. DOI: 10.1172/JCI115996. View

13.

Chitturi S, Abeygunasekera S, Farrell G, Holmes-Walker J, Hui J, Fung C . NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002; 35(2):373-9. DOI: 10.1053/jhep.2002.30692. View

14.

Lupascu A, Gabrielli M, Lauritano E, Scarpellini E, Santoliquido A, Cammarota G . Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005; 22(11-12):1157-60. DOI: 10.1111/j.1365-2036.2005.02690.x. View

15.

Mitsui T, Shimaoka K, Goto Y, Kagami H, Kinomoto H, Ito A . Small bowel bacterial overgrowth is not seen in healthy adults but is in disabled older adults. Hepatogastroenterology. 2006; 53(67):82-5. View

16.

BONDAR G, PISESKY W . Complications of small intestinal short-circuiting for obesity. Arch Surg. 1967; 94(5):707-16. DOI: 10.1001/archsurg.1967.01330110123016. View

17.

Yang C, Chang C, Chen G . Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests. Scand J Gastroenterol. 1998; 33(8):867-71. DOI: 10.1080/00365529850171549. View

18.

Harnois F, Msika S, Sabate J, Mechler C, Jouet P, Barge J . Prevalence and predictive factors of non-alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery. Obes Surg. 2006; 16(2):183-8. DOI: 10.1381/096089206775565122. View

19.

James O, Day C . Non-alcoholic steatohepatitis (NASH): a disease of emerging identity and importance. J Hepatol. 1998; 29(3):495-501. DOI: 10.1016/s0168-8278(98)80073-1. View

20.

Elphick D, Chew T, Higham S, Bird N, Ahmad A, Sanders D . Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?. Gerontology. 2005; 51(6):396-401. DOI: 10.1159/000088704. View