Association between small intestinal bacterial overgrowth and peripheral bacterial DNA in cirrhotic patients.
BACKGROUND
Small intestinal bacterial overgrowth (SIBO) is regarded as the major risk factor of bacterial translocation. Few studies have investigated the direct relation between SIBO and translocation in cirrhotic patients. The purpose of this study is to examine the correlation between SIBO and bacterial DNA in the peripheral blood of patients with cirrhosis.


OBJECTIVE
The purpose of this study is to examine the correlation between SIBO and bacterial DNA in the peripheral blood of patients with cirrhosis.


METHODS
Fifty-three cirrhosis cases and 42 controls underwent a lactulose breath test (LBT) every 15 min for 180 min. To detect and identify the presence of bacterial DNA fragments in peripheral blood, multiplex polymerase chain reaction (PCR) was performed.


RESULTS
The positive rate of LBT was significantly different between the two groups: 60.4% in the patient group and 28.6% in the controls. The SIBO positive rate was 81.3% in the cirrhosis patients with ascites, which was significantly higher than 51.4% in the cirrhosis patients with no ascites (P = 0.03). Eight of the nine patients (88.9%) who had a history of one or more hepatic encephalopathy was SIBO-positive, which was higher than the patients who had had no hepatic encephalopathy. In the cirrhosis group, 32 patients (60.4%) were SIBO-positive, and ten of them (31.3%) were bacterial DNA-positive. Only one case (4.8%) was bacterial DNA-positive in the absence of SIBO-positive. In a multivariate analysis, only the existence of SIBO was the independent risk factor for bacterial DNA (P = 0.026).


CONCLUSIONS
SIBO in cirrhosis patients was observed at a very high frequency, and SIBO showed a high correlation with bacterial translocation, suggesting that SIBO could be a major risk factor of bacterial translocation, especially in ascitic patients.
Jun
Dae Won
DW
Department of Internal Medicine, Eulji University, Eulji Hospital, Seoul, Korea.
Kim
Kyung Tae
KT
Lee
Oh Young
OY
Chae
Jeong Don
JD
Son
Byoung Kwan
BK
Kim
Seong Hwan
SH
Jo
Yun Ju
YJ
Park
Young Sook
YS
D000328:Adult; D001419:Bacteria / Q000254:growth & development*; D018988:Bacterial Translocation; D001944:Breath Tests; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004269:DNA, Bacterial / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007421:Intestine, Small / Q000382:microbiology*; D008103:Liver Cirrhosis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D004269:DNA, Bacterial; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha