title: Small intestinal bacterial overgrowth and delayed orocecal transit time in patients with cirrhosis and low-grade hepatic encephalopathy.
abstract: BACKGROUND
  Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Gut-derived nitrogenous substances play a role in pathogenesis of HE. The present study was conducted to assess small intestinal bacterial overgrowth (SIBO) and prolonged orocecal transit time (OCTT) in cirrhosis and low-grade HE.
  
  
  METHODS
  In cross-sectional prospective study, 75 patients were divided into 3 groups: group 1 (no HE, n = 31), group 2 (minimal HE, n = 29), and group 3 (early/grade 1 HE, n = 15). Minimal HE (MHE) was diagnosed when psychometric hepatic encephalopathy score (PHES) was ≤5. Early HE was diagnosed, according to West Haven criteria. All patients underwent glucose hydrogen breath test (GHBT) for SIBO and lactulose hydrogen breath test (LHBT) for OCTT.
  
  
  RESULTS
  A total of 29 patients (38.67 %) had MHE and 15 (20 %) had early HE. Prevalence of MHE in Child-Turcotte-Pugh (CTP) class A, B, and C was 33.3, 38.71, and 45 %, respectively, while SIBO was detected in 26 (34.67 %). Prevalence of SIBO was 12.5 % in CTP class A, 41.94 % in CTP class B, and 50 % in CTP class C. Five (16.13 %) patients in no HE group had SIBO as compared to 14 (48.28 %) in MHE group and 7 (46.67 %) in early HE group (p = 0.018). OCTT was 111.13 ± 13.95 min in patients with no HE as compared to 137.59 ± 14.80 min in patients with MHE and 150 ± 15.12 min in patients with early HE (p < 0.001). OCTT was significantly prolonged in patients with SIBO (145 ± 17.49 min) than in those without SIBO (120.71 ± 18.3 min) (p < 0.001).
  
  
  CONCLUSIONS
  SIBO and delayed OCTT are more common with MHE and early HE in patients with cirrhosis.
authors.affiliation: Department of Gastroenterology, G B Pant Hospital, 203, Academic Block, New Delhi, 110002, India.
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Lunia
authors.affiliation: Department of Gastroenterology, G B Pant Hospital, 203, Academic Block, New Delhi, 110002, India. drbcsharma@hotmail.com.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, G B Pant Hospital, 203, Academic Block, New Delhi, 110002, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
keywords: Cirrhosis; Hepatic encephalopathy; Orocecal Transit time; Small intestinal bacterial overgrowth