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Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy.
J Hepatol 2010; 53(5):849-55JH

Abstract

BACKGROUND & AIMS

Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encephalopathy. This cross-sectional study was carried out to elucidate the role of bacterial overgrowth of the small intestine and delayed intestinal transit among patients with MHE.

METHODS

Two-hundred-thirty patients with cirrhosis were screened; 102 patients (44.4%) who met the eligibility criteria were included in the study. MHE was diagnosed when the psychometric hepatic encephalopathy score was ≤-5. All patients underwent a glucose breath test for small intestinal bacterial overgrowth (SIBO) and lactulose breath test for oro-cecal transit time (OCTT).

RESULTS

Fifty-seven (55.9%) patients with cirrhosis had MHE. Among these patients with MHE, 22 (38.6%) had SIBO, while 4 (8.9%) without MHE had SIBO (p = 0.001). The prevalence of SIBO was higher in patients with CTP classes B and C (69.2%) compared to those in CTP class A (30.8%); p = 0.054. OCTT was significantly prolonged in patients who had SIBO than in those who did not have SIBO (p<0.0001). Univariate analysis demonstrated that increased age, female gender, low educational status, low albumin, presence of SIBO, and prolonged OCTT were associated with the presence of MHE. Multivariate analysis demonstrated SIBO as the only factor associated with MHE.

CONCLUSIONS

Our study conclusively demonstrates high prevalence of SIBO in patients with cirrhosis with MHE. This study gives the rationale of treatment directed against SIBO and gut dysmotility, which may include non-absorbable antibiotics such as rifaximin, probiotics, and prokinetics.

Authors+Show Affiliations

Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20675008

Citation

Gupta, Ankur, et al. "Role of Small Intestinal Bacterial Overgrowth and Delayed Gastrointestinal Transit Time in Cirrhotic Patients With Minimal Hepatic Encephalopathy." Journal of Hepatology, vol. 53, no. 5, 2010, pp. 849-55.
Gupta A, Dhiman RK, Kumari S, et al. Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. J Hepatol. 2010;53(5):849-55.
Gupta, A., Dhiman, R. K., Kumari, S., Rana, S., Agarwal, R., Duseja, A., & Chawla, Y. (2010). Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. Journal of Hepatology, 53(5), pp. 849-55. doi:10.1016/j.jhep.2010.05.017.
Gupta A, et al. Role of Small Intestinal Bacterial Overgrowth and Delayed Gastrointestinal Transit Time in Cirrhotic Patients With Minimal Hepatic Encephalopathy. J Hepatol. 2010;53(5):849-55. PubMed PMID: 20675008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy. AU - Gupta,Ankur, AU - Dhiman,Radha K, AU - Kumari,Savita, AU - Rana,Satyavati, AU - Agarwal,Ritesh, AU - Duseja,Ajay, AU - Chawla,Yogesh, Y1 - 2010/07/17/ PY - 2009/12/22/received PY - 2010/04/22/revised PY - 2010/05/17/accepted PY - 2010/8/3/entrez PY - 2010/8/3/pubmed PY - 2011/2/2/medline SP - 849 EP - 55 JF - Journal of hepatology JO - J. Hepatol. VL - 53 IS - 5 N2 - BACKGROUND & AIMS: Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encephalopathy. This cross-sectional study was carried out to elucidate the role of bacterial overgrowth of the small intestine and delayed intestinal transit among patients with MHE. METHODS: Two-hundred-thirty patients with cirrhosis were screened; 102 patients (44.4%) who met the eligibility criteria were included in the study. MHE was diagnosed when the psychometric hepatic encephalopathy score was ≤-5. All patients underwent a glucose breath test for small intestinal bacterial overgrowth (SIBO) and lactulose breath test for oro-cecal transit time (OCTT). RESULTS: Fifty-seven (55.9%) patients with cirrhosis had MHE. Among these patients with MHE, 22 (38.6%) had SIBO, while 4 (8.9%) without MHE had SIBO (p = 0.001). The prevalence of SIBO was higher in patients with CTP classes B and C (69.2%) compared to those in CTP class A (30.8%); p = 0.054. OCTT was significantly prolonged in patients who had SIBO than in those who did not have SIBO (p<0.0001). Univariate analysis demonstrated that increased age, female gender, low educational status, low albumin, presence of SIBO, and prolonged OCTT were associated with the presence of MHE. Multivariate analysis demonstrated SIBO as the only factor associated with MHE. CONCLUSIONS: Our study conclusively demonstrates high prevalence of SIBO in patients with cirrhosis with MHE. This study gives the rationale of treatment directed against SIBO and gut dysmotility, which may include non-absorbable antibiotics such as rifaximin, probiotics, and prokinetics. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/20675008/Role_of_small_intestinal_bacterial_overgrowth_and_delayed_gastrointestinal_transit_time_in_cirrhotic_patients_with_minimal_hepatic_encephalopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(10)00616-1 DB - PRIME DP - Unbound Medicine ER -