A relationship has been reported between the severity of liver failure and the intensity of small intestinal motility disturbances. There are scanty data in literature about the prevalence of SIBO in cirrhotics and its relationship to severity of liver disease. 9 Furthermore, manipulation of gut flora, to augment the intestinal content of lactic acid-type bacteria at the expense of other gut flora species with more pathogenic potential, may favourably influence liver function in cirrhotic patients. 3, 8 Recent studies also suggest that gut flora, both in the colon and small intestine, may contribute to the proinflammatory state of cirrhosis even in the absence of overt infection. SIBO and increased bacterial translocation of gut flora from the intestinal lumen, in combination with failure of immune defence mechanisms to remove efficiently these translocating microorganisms, predispose to an increased potential for bacterial infections like spontaneous bacterial peritonitis (SBP) and sepsis in this group. In addition to the range of symptoms and consequences of SIBO per se, increasing evidence suggests that derangement of gut flora is of substantial clinical relevance to patients with cirrhosis. 4 This has been attributed, at least in part, to a decrease in small intestinal motility and increased adrenergic activity due to cirrhosis. 1- 3 Significantly increased counts of both Gram-positive and -negative bacterial species have been recovered from faeces of cirrhotic patients. Ascites and raised serum bilirubin reliably predicted presence of SIBO.ĭerangement of gut flora, in particular, small-intestinal bacterial overgrowth (SIBO) is highly prevalent in patients with cirrhosis. Its frequency increased with increase in severity of cirrhosis. Patients having combination of ascites and serum bilirubin ≥2 mg/dL had 82% chance, while patients having neither had only 10% chance of having SIBO.Ĭonclusions Small-intestinal bacterial overgrowth was prevalent in about half of cirrhotics. The best cut-off of serum bilirubin was ≥2 mg/dL predicting SIBO with sensitivity 65%, specificity 81%, positive predictive value 77%, negative predictive value 71% and accuracy 74%.
On multivariate analysis, SIBO was independently associated with serum bilirubin and ascites. The prevalence of SIBO increased with severity of cirrhosis (Child–Pugh A 20%, B 52% and C 73% P = 0.013).
Results Of the 53 cirrhotics, 26 (49%) had SIBO, compared to one (8%) control ( P = 0.010). Prevalence of SIBO in cirrhotics was compared with healthy controls and correlated with severity of cirrhosis. A basal breath-hydrogen >20 ppm or a rise by ≥12 ppm above baseline following glucose administration was taken as positive test. Methods Small-intestinal bacterial overgrowth was determined by glucose–hydrogen breath test (GHBT).
Background Small-intestinal bacterial overgrowth (SIBO) is known to be present in patients with cirrhosis, predisposing to various complications.Īim To determine the frequency of SIBO in cirrhotics and correlate with severity of cirrhosis.
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