肝硬化患者病情与小肠细菌过度生长变化关系探讨

目的 探讨小肠细菌过度生长（SIBO）与肝硬化病情严重程度的关系及小肠细菌生长与降钙素原、胆红素、血浆白蛋白、球蛋白的相关性。方法 纳入本科收治的47例肝硬化患者和15名健康志愿者。受试者接受乳果糖氢呼气试验（LHBT）,检测小肠细菌过度生长情况,使用全自动生化分析仪测定生化指标。采用自评表形式对肝硬化组患者症状进行评估。结果 在15名健康志愿者中检出1例（6.6%）伴小肠细菌过度生长,而在47例肝硬化患者中检出22例（46.8%）患者伴小肠细菌过度生长,显著高于正常人（P＜0.01）;肝硬化患者LHBT集值为（157.81±98.32）ppm,显著高于健康人[(38.87±16.05）ppm,P＜0.01],血清胆红素为（93.31±55.15）μmol/L,显著高于健康人[（14.78±8.12）μmol/L,P＜0.01],白蛋白为（31.74±10.37）g/L,显著低于健康人[(43.90±7.63) g/L, P＜0.01],球蛋白为（39.09±5.07）g/L,高于健康人[(35.94±2.31) g/L,P＞0.05],降钙素原为（0.10±0.07）ng/ml,显著高于健康人[(0.03±0.01) ng/ml,P＜0.01];降钙素原、胆红素、血浆白蛋白、球蛋白与LHBT集值具有相关性（r=0.895、P＜0.005,r=0.907、P＜0.005,r=-0.810、P＜0.005,r=0.755,P＜0.005）。结论 肝硬化患者SIBO发生率随肝功能损害程度的加重而增加,肝硬化SIBO患者腹胀及食欲不振更明显。降钙素原、胆红素和球蛋白分别与SIBO呈正相关,血浆白蛋白与SIBO呈负相关。     

Small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth (SIBO) syndrome is characterized in its florid form by diarrhoea and weight loss. The most common underlying factors are dysmotility, small intestinal obstruction, blind or afferent loops. Small intestinal bacterial overgrowth can be diagnosed by: 1) culture of jejunum aspirate for bacterial counts, 2) 14C-D-xylose breath testing, 3) non-invasive hydrogen breath testing using glucose or lactulose or 4) 14C-glycocholic acid breath testing. The treatment usually consists of the eradication of bacterial overgrowth with repeated course of antimicrobials, correction of associated nutritional deficiencies and, when possible, correction of the underlying predisposing conditions.     

Small intestinal bacterial overgrowth

Despite the current increase in interest in the role of the microbiota in health and disease and the recognition, for over 50 years, that an excess of colonic-type flora in the small intestine could lead to a malabsorption syndrome, small intestinal overgrowth remains poorly defined. This lack of clarity owes much to the difficulties that arise in attempting to arrive at consensus with regard to the diagnosis of this condition: there is currently no gold standard and the commonly available methodologies (the culture of jejunal aspirates and a variety of breath tests) suffer from considerable variations in their performance and interpretation, leading to variations in the prevalence of overgrowth in a variety of clinical contexts. Treatment is similarly supported by a scant evidence base and the most commonly used antibiotic regimens owe more to custom than clinical trials.     

Small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth (SIBO) syndrome is characterized in its florid form by diarrhoea and weight loss. The most common underlying factors are dysmotility, small intestinal obstruction, blind or afferent loops. Small intestinal bacterial overgrowth can be diagnosed by: 1) culture of jejunum aspirate for bacterial counts, 2) ¹⁴C-D-xylose breath testing, 3) non-invasive hydrogen breath testing using glucose or lactulose or 4) ¹⁴C-glycocholic acid breath testing. The treatment usually consists of the eradication of bacterial overgrowth with repeated course of antimicrobials, correction of associated nutritional deficiencies and, when possible, correction of the underlying predisposing conditions.     

Small intestinal bacterial overgrowth in North Indian patients with celiac disease.

BACKGROUND: Occasionally celiac patients continue to experience gastro-intestinal symptoms even with a gluten free diet. In these cases, small intestinal bacterial overgrowth may be one of the causes of the lack of response. Therefore, this prospective study was planned to determine the prevalence of small intestinal bacterial overgrowth in celiac patients. MATERIALS AND METHODS: We studied 87 confirmed cases of celiac disease from North India and 87 age and sex matched controls. Celiac disease was confirmed by positive IgA antitissue transglutaminase on ELISA. 80 g glucose hydrogen breath test (non-invasive test) was performed to establish small intestinal bacterial overgrowth. Rise of more than 10 ppm in hydrogen concentration over baseline value within two hours was considered suggestive of small intestinal bacterial overgrowth. RESULTS: Out of 87 patients with celiac disease, 49 were male and 38 were female.The mean (+/-SD) age for male patients was 26.3 +/- 16.3 years (range 14-59 years) and for female patients was 28.4 +/- 15.6 years (range 16-58 years). Amongst the controls, 52 (59.8%) were male and 35 (40.2%) were female. The mean (+/- SD) age for male controls was 27.6 +/- 14.5 years (range 15-57 years) and for female controls was 29.3 +/- 16.5 years (range 18-59 years). Hydrogen breath test was suggestive of bacterial overgrowth in 18 of the 87 (20.7%) celiac disease patients but not in any of the apparently healthy controls. CONCLUSION: This study indicates that a large number of celiac patients from North India suffer from bacterial overgrowth which can be accordingly treated with antibiotics.     

Small intestinal bacterial overgrowth in patients with irritable bowel syndrome

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) has been proposed to be common in irritable bowel syndrome (IBS), with altered small-bowel motility as a possible predisposing factor. AIM: To assess the prevalence of SIBO, by culture of small-bowel aspirate, and its correlation to symptoms and motility in IBS. METHODS: 162 patients with IBS who underwent small-bowel manometry and culture of jejunal aspirate were included. Cultures from 26 healthy subjects served as controls. Two definitions of altered flora were used: the standard definition of SIBO (>/=10(5) colonic bacteria/ml), and mildly increased counts of small-bowel bacteria (>/=95th centile in controls). RESULTS: SIBO (as per standard definition) was found in 4% of both patients and controls. Signs of enteric dysmotility were seen in 86% of patients with SIBO and in 39% of patients without SIBO (p = 0.02). Patients with SIBO had fewer phase III activities (activity fronts) than patients without SIBO (p = 0.08), but otherwise no differences in motility parameters were seen. Mildly increased bacterial counts (>/=5x10(3)/ml) were more common in patients with IBS than in controls (43% vs 12%; p = 0.002), but this was unrelated to small intestinal motility. No correlation between bacterial alterations and symptom pattern was observed. CONCLUSIONS: The data do not support an important role for SIBO according to commonly used clinical definitions, in IBS. However, mildly increased counts of small-bowel bacteria seem to be more common in IBS, and needs further investigation. Motility alterations could not reliably predict altered small-bowel bacterial flora.     

Small intestinal bacterial overgrowth syndrome

Human intestinal microbiota create a complex polymi-crobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO).SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastro-intestinal tract. There...     

Small intestinal bacterial overgrowth syndrome

Opinion statement Small intestinal bacterial overgrowth is found in many conditions and may present with malabsorption, diarrhea, and malnutrition. Whereas dietary modifications and supplements might help, the primary treatment strategy is the judicious use of antibiotics. The most effective antibiotics, shown either empirically or by clinical trials, are the quinolones, tetracycline, amoxicillin with clavulanic acid, clindamycin, and metronidazole. In an unpredictable fashion, some patients fail to respond to one of these antibiotics, but often will respond to a second. These conditions are often chronic and require periodic or cyclical treatment. In some conditions seen in the elderly or in hypochlorhydric patients the small intestinal bacterial overgrowth is inconsequential and does not require therapy. Surgical management is reserved for the select situations in which there is a clear-cut structural defect.     

Small intestinal bacterial overgrowth versus antimicrobial capacity in patients with spontaneous bacterial peritonitis

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic patients with ascites. Both defects in the host defense mechanisms and the enhancement of the offensive factor (small intestinal bacterial overgrowth (SIBO)) may contribute to the development of SBP. Therefore, the aim of this study was to evaluate the role of SIBO versus various antimicrobial capacities in the pathogenesis of SBP in cirrhotic patients. METHODS: Forty-five cirrhotic patients were enrolled in this study. Bacterial overgrowth was evaluated by breath hydrogen test (BH2T). The hepatic reticuloendothelial system phagocytic index (HRESPI) was measured by intravenously injected colloid suspensions. RESULTS: The Child-Pugh scores in the SBP group were higher than in the non-SBP group (10.5 +/- 2.0 versus 8.0 +/- 1.8, P < 0.01). The ascitic protein concentration was significantly lower in the SBP group than in the non-SBP group (897 +/- 425 mg/l versus 1,325 +/- 453 mg/l, P < 0.01). Furthermore, the serum C3 concentration was lower in the SBP group than in the non-SBP group (43.1 +/- 13.6 ng/dl versus 73.2 +/- 26.4 ng/dl, P < 0.01). The serum C4 concentration was also lower in the SBP group than in the non-SBP group (12.4 +/- 4.0 ng/dl versus 16.9 +/- 6.6 ng/dl, P < 0.05). The incidence of SIBO was higher in the SBP group than in the non-SBP group (68.2% versus 17.4%, P < 0.01). HRESPI values were significantly higher in the two groups of cirrhotic patients than in the normal reference. However, there were no statistical differences in HRESPI between the two groups (8.4 +/- 2.8 min in the SBP group versus 7.9 +/- 2.8 min in the non-SBP group). CONCLUSIONS: The results of this study showed that the hepatic reticuloendothelial function is impaired in cirrhotic patients, but the degree of impairment does not differ between patients with and without previous history of SBP. Lower ascitic total protein, lower serum C3 and C4 concentrations, and presence of SIBO are all risk factors for SBP. Based on the results of our study, defects in the host defense mechanisms and the enhancement of the offensive factor (SIBO) may act in concert for the development of SBP.     

Small intestinal bacterial overgrowth and intestinal permeability

Abstract

Objective. Capsule endoscopy (CE) is the gold standard to diagnose small bowel bleeding. The “suspected blood indicator” (SBI) offers an automated detection of active small bowel bleeding but validity of this technique is unknown. The objective was to analyze specificity and sensitivity of the SBI using the second small bowel capsule generation for the detection of active bleeding. Methods. This is a retrospective analysis of all patients (199) who attended our clinic for CE from June 2008 through March 2013. The second-generation PillCam SB 2 capsule was used for detection of (1) luminal blood content and (2) potentially responsible small bowel lesions. The findings of an independent investigator were correlated to SBI findings and a number of SBI markings were analyzed by a receiver operating characteristic (ROC). Results. In 157/199 cases, no sign of active bleeding or altered blood was detected. One hundred and thirty-seven of these 157 cases provided at least one SBI marking and a mean of 18.4 positive SBI markings per record were found. In 20 cases, neither SBI nor the human investigator detected abnormalities. Thirteen patients showed investigator-detected minor bleeding with mean SBI findings of 36 positive screenshots per record. When major bleeding was diagnosed by the investigator (n = 29), SBI detected a mean of 46.6 SBI-positive markings. SBI turned positive in 179 patients, whereas the investigator detected active bleeding in 42 cases. All patients with active bleeding were detected by SBI (sensitivity 100%, specificity 13%). ROC analysis revealed 51.0 SBI markings being the optimal cutoff for active versus no bleeding (sensitivity 79.1%, specificity 90.4%, misclassification of 15.3%). Conclusion. The new SBI software is a reliable tool to exclude active bleeding and/or major lesions but analysis of the CE video by a trained investigator is still important for the detection of lesions responsible for past bleeding.     

慢性肝病小肠细菌过度生长与内毒素血症

目的观察慢性肝病患者小肠细菌过度生长(SIBO)的情况与内毒素、血小板源生长因子PDGF)水平及血清肝纤维化指标的关系。方法采用乳果糖氢呼气试验(LHBT)检测64例慢性肝病患者SIBO情况,鲎试验检测血浆内毒素,双抗体夹心ELISA检测PDGF,放免法检测透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原肽氨基末端肽(PⅢNP)、Ⅳ型胶原(Ⅳ.C)水平。分析SIBO与内毒素、血清肝纤维化指标之间的关系。结果64例慢性肝病患者中,LHBT阳性22例(34.4%),慢性肝病伴与不伴SIBO的血浆内毒素为(62±19)和(31±13)pg/ml;PDGF为(211±77)和(136±57)pg/ml;HA为649±189)和(394±210)ng/ml;LN为(139±24)和(110±35)μg/L;Ⅳ.C为(156±41)和(112±51)μg/L;PⅢNP为(32±10)和(21±12)μg/L(P值均<0.01)。慢性肝病患者血浆内毒素水平与PDGF水平呈直线正相关(r=0.803,P<0.01);血浆内毒素、PDGF水平与血清肝纤维化指标呈正相关。结论SIBO是慢性肝病患者出现高内毒素血症的原因之一,其引起的肠源性内毒素血症可能参与促进肝纤维化发生、发展的过程。     

Small intestinal bacterial overgrowth in patients with cirrhosis: prevalence and relation with spontaneous bacterial peritonitis

OBJECTIVES: The significance of small intestinal bacterial overgrowth in patients with cirrhosis is not fully understood and its diagnostic criteria are not uniform. We examined the association of small intestinal bacterial overgrowth with spontaneous bacterial peritonitis and compared various microbiological criteria. METHODS: Jejunal secretions from 70 patients with cirrhosis were cultivated quantitatively and classified according to various definitions. Clinical characteristics of patients were evaluated and the incidence of spontaneous bacterial peritonitis was monitored during a 1-yr follow-up. RESULTS: Small intestinal bacterial overgrowth, defined as > or = 10(5) total colony-forming units/ml jejunal secretions, was present in 61% of patients. Small intestinal bacterial overgrowth was associated with acid-suppressive therapy (p = 0.01) and hypochlorhydria (p < 0.001). Twenty-nine patients with persistent ascites were observed. Six episodes of spontaneous bacterial peritonitis occurred after an average 12.8 wk. Occurence of spontaneous bacterial peritonitis correlated with ascitic fluid protein concentration (p = 0.01) and serum bilirubin (p = 0.04) but not with small intestinal bacterial overgrowth (p = 0.39). Its association with acid-suppressive therapy was of borderline significance (hazard ratio = 7.0, p = 0.08). CONCLUSIONS: Small intestinal bacterial overgrowth in cirrhotic patients is associated with acid-suppressive therapy and hypochlorhydria, but not with spontaneous bacterial peritonitis. The potential role of acid-suppressive therapy in the pathogenesis of spontaneous bacterial peritonitis merits further studies.     

Small intestinal bacterial overgrowth recurrence after antibiotic therapy

OBJECTIVES:  Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad-spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence.
METHODS:  Eighty consecutive patients affected by SIBO and decontaminated by rifaximin (1,200 mg per day for 1 wk) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after evidence of GBT normalization. GBT positivity recurrence, predisposing conditions, and gastrointestinal symptoms were evaluated.
RESULTS:  Ten (10/80, 12.6%), 22 (22/80, 27.5%), and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6, and 9 months after successful antibiotic treatment, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02–1.16), history of appendectomy (OR 5.9, 95% CI 1.45–24.19), and chronic use of proton pump inhibitors (PPIs) (OR 3.52, 95% CI 1.07–11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6, and 9 months in patients with evidence of GBT positivity recurrence.
CONCLUSIONS:  GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.     

Small intestinal bacterial overgrowth: diagnosis and treatment

Small intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by a malabsorption syndrome due to an increase in microorganisms within the small intestine. The main mechanisms restricting bacterial colonization in the upper gut are the gastric acid barrier, mucosal and systemic immunity and intestinal clearance. When these mechanisms fail, bacterial overgrowth develops. Diarrhea, steatorrhea, chronic abdominal pain, bloating and flatulence are common symptoms and are similar to those observed in irritable bowel syndrome. Breath tests (glucose and/or lactulose breath tests) have been proposed as a sensitive and simple tool for the diagnosis of bacterial overgrowth, being non-invasive and inexpensive compared to the gold standard represented by the culture of intestinal aspirates. Antibiotic therapy is the cornerstone of SIBO treatment. Current SIBO treatment is based on empirical courses of broad-spectrum antibiotics since few controlled studies concerning the choice and duration of antibiotic therapy are available at present.     

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome

<正>Objective To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic lowgrade inflammation in patients with irritable bowel syndrome (IBS). Methods From June to October in 2017,50 cases of IBS patients who met RomeⅣcriteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath     

Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease

Background  

Small intestinal bacterial overgrowth (SIBO) is characterized by excessive proliferation of colonic bacterial species in the small bowel. Potential causes of SIBO include fistulae, strictures or motility disturbances. Hence, patients with Crohn's Disease (CD) are especially predisposed to develop SIBO. As result, CD patients may experience malabsorption and report symptoms such as weight loss, watery diarrhea, meteorism, flatulence and abdominal pain, mimicking acute flare in these patients.     

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis

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 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.     

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis

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 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.This study was supported in part by a grant (No. 91/0675) from Fondo de Investigaciones Sanitarias (FIS), Madrid, Spain.This article originally appeared inDigestive Diseases and Sciences, Volume 40, Number 6, June 1995, pp. 1252–1256.