title: Bowel bacterial overgrowth as another cause of malnutrition, inflammation, and atherosclerosis syndrome in peritoneal dialysis patients.
abstract: Bowel bacterial overgrowth syndrome (BBOS) is an important cause of gastrointestinal (GI) abnormalities. Proinflammatory cytokines (PICs) are excessively produced and accumulate because of kidney failure in dialysis patients who experience chronic infections such as BBOS. We explored the association between GL function, BBOS, and the malnutrition, inflammation, and atherosclerosis (MIA) syndrome. We studied GI malabsorption and maldigestion by analyzing fecal starch, sugar, fat, and nitrogen; intestinal protein permeability (alpha1-antitrypsin fecal clearance); and fecal chymotrypsin. We evaluated BBOS by breath hydrogen test (BHT) after a 3-day fat-and-carbohydrate-overload diet. Positive BHT was present in 10 patients, showing a high prevalence of GI macronutrient malabsorption and maldigestion, and compared with the other patients, the highest plasma levels of tumor necrosis factor alpha and interleukin 6 and lower levels of albumin and prealbumin. Those 10 patients were treated with a combination of several antibiotics, including neomycin, amoxicillin-clavulanate, and quinolones. Between 2 and 3 months later, the BHT, markers of nutrition, and PIC were re-tested. All treated patients showed an improvement in nutrition status and a lesser inflammatory pattern. The BBOS infectious process is found frequently in dialysis patients in association with GI malabsorption and maldigestion, malnutrition, and systemic inflammation. Hyperproduction of PIC because of BBOS induces MIA through a double pathway: GI disorders and deleterious systemic effects.
authors.affiliation: Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Spain. aguileraa@terra.es
authors.forename: Abelardo
authors.initials: A
authors.lastname: Aguilera
authors.forename: Liliana
authors.initials: L
authors.lastname: Gonzalez-Espinoza
authors.forename: Rosa
authors.initials: R
authors.lastname: Codoceo
authors.forename: Maria del Carmen
authors.initials: Mdel C
authors.lastname: Jara
authors.forename: Mario
authors.initials: M
authors.lastname: Pavone
authors.forename: Maria Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.forename: Gloria
authors.initials: G
authors.lastname: Del Peso
authors.forename: Olga
authors.initials: O
authors.lastname: Celadilla
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Martínez
authors.forename: Manuel
authors.initials: M
authors.lastname: López-Cabrera
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000209:etiology*; D001765:Blind Loop Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D001944:Breath Tests; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007249:Inflammation / Q000209:etiology; D015850:Interleukin-6 / Q000097:blood; D007408:Intestinal Absorption; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D008875:Middle Aged; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000009:adverse effects; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein