Digestive Diseases and Sciences

, Volume 40, Issue 6, pp 1252–1256 | Cite as

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis

  • F. Casafont Morencos
  • G. de las Heras Castano
  • L. Martín Ramos
  • Maria J. López Arias
  • F. Ledesma
  • F. Pons Romero
Liver: Cirrhosis, Fibrosis, Portal Hypertension, And Transplantation

Abstract

A total of 89 patients with alcoholic cirrhosis and 40 healthy subjects were included in a study to assess the prevalence of intestinal bacterial overgrowth and to analyze its relationship with the severity of liver dysfunction, presence of ascites, and development of spontaneous bacterial peritonitis (SBP). Bacterial overgrowth was measured by means of a breath test after ingestion of glucose. Intestinal bacterial overgrowth was documented in 27 (30.3%) of the 89 patients with alcoholic cirrhosis and in none of the healthy subjects. The prevalence of intestinal bacterial overgrowth was significantly higher in cirrhotics with ascites (37.1%) than in those with no evidence of ascites (5.3%) and among patients with Pugh-Child class C (48.3%) than in patients with class A (13.1%) or B (27%). Twelve (17.1%) of the 70 patients with ascites developed an episode of SBP. The prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth (30.7%) than in patients who did not (9.09%). We conclude that intestinal bacterial overgrowth occurs in approximately one third of patients with cirrhosis secondary to alcohol, particularly in patients with ascites and advanced liver dysfunction. Moreover, bacterial overgrowth may be a condition favoring infection of the ascitic fluid.

Key words

alcoholic liver cirrhosis intestinal bacterial overgrowth bacterial translocation ascites spontaneous bacterial peritonitis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Alexander JW, Boyce ST, Babcock GF, Gianotti L, Peck MD, Dunn DL, Pyles T, Childress CP, Ash SK: The process of microbial translocation. Ann Surg 212:496–512, 1990PubMedGoogle Scholar
  2. 2.
    Deitch EA, Berg R: Bacterial translocation from the gut: A mechanism of infection. J Burn Care Rehab 8:475–482, 1987Google Scholar
  3. 3.
    Bode J, Bode C, Heidelbach R, Durr HK, Martini GA: Jejunal microflora in patients with chronic alcohol abuse. Hepatogastroenterol 31:30–34, 1984Google Scholar
  4. 4.
    Lembcke B, Kraus B, Lankish PG: Small intestinal function in chronic relapsing pancreatitis. Hepatogastroenterology 32:149–151, 1985PubMedGoogle Scholar
  5. 5.
    Bode CH, Kolepke K, Schäfer K, Bode JCh: Hydrogen breath test in patients with alcoholic liver disease: Evidence for bacterial overgrowth in the small intestine. J Hepatol 11:S9, 1990 (abstract)Google Scholar
  6. 6.
    Potela-Gomes G, Pinto-Correia J, Dantas R, Pires IR, Laranjeira MR, Figuereido A: Jejunal microflora in patients with liver cirrhosis. Arq Gastroenterol (Sao Paulo) 14:72–75, 1977Google Scholar
  7. 7.
    Baraona E, Julkunen R, Tannenbaum L, Lieber CS: Role of intestinal bacterial overgrowth in ethanol production and metabolism in rats. Gastroenterology 90:13–100, 1986Google Scholar
  8. 8.
    Pugh RNH, Murray-Lyon IM, Dawson JK, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649, 1973PubMedGoogle Scholar
  9. 9.
    Kerlin P, Wong L: Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 95:982–988, 1988PubMedGoogle Scholar
  10. 10.
    Isaacs PET, Kim YS: The contaminated small bowel syndrome. Am J Med 67:1049–1057, 1979PubMedGoogle Scholar
  11. 11.
    Corazza GR, Menozzi MG, Strochi A, Rasciti L, Vaira D, Lecchini R, Avanzini P, Chezzi C, Gasbarrini G: The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology 98:302–309, 1990PubMedGoogle Scholar
  12. 12.
    Metz G, Gassull MA, Drasar BS, Jenkins DJA, Blendis LM: Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet 1:668–669, 1976PubMedGoogle Scholar
  13. 13.
    Wegener M, Schaffstein J, Dilger U, Coenen C, Wedmann B, Schmidt G: Gastrointestinal transit of solid-liquid meal in chronic alcoholics. Dig Dis Sci 36:917–923, 1991PubMedGoogle Scholar
  14. 14.
    Huppe D, Tonissen R, Hofius M, Kuntz HD, May B: Influence of chronic alcoholism and liver cirrhosis on oro-cecal transit (H2 breath test). Z Gastroenterol 27:624–628, 1989PubMedGoogle Scholar
  15. 15.
    Reilly JA Jr, Quigley EMM, Forst CF, Rikkers LF: Small intestinal transit in the portal hypertensive rat. Gastroenterology 100:6700–674, 1991Google Scholar
  16. 16.
    Granger DN, Barrowman JA: Microcirculation of the alimentary tract. II. Pathophysiology of edema. Gastroenterology 84:1035–1039, 1983PubMedGoogle Scholar
  17. 17.
    Scott LD, Summers RW: Effect of glucagon and caerulein on propulsion and motility in the rat small intestine. Gastroenterology 66:A-120/774, 1974 (abstract)Google Scholar
  18. 18.
    Inou F, Frank GB: Effects of ethyl alcohol on excitability and on neuromuscular transmission in frog skeletal muscle. Br J Pharmcol Chemother 30:186–193, 1967Google Scholar
  19. 19.
    Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E: The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med 320:409–415, 1989PubMedGoogle Scholar
  20. 20.
    Caly WR, Strauss E: A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 18:353–358, 1993PubMedGoogle Scholar
  21. 21.
    Ledesma F, Echevarria S, Casafont F, Lozano JL, Pons-Romero F: Natural killer cell activity in alcoholic cirrhosis: Influence of nutrition. Eur J Clin Nutr 44:733–740, 1990PubMedGoogle Scholar
  22. 22.
    Kirsch M: Bacterial overgrowth. Am J Gastroenterol 85:231–237, 1990PubMedGoogle Scholar
  23. 23.
    Lichtman SN, Sartor RB, Keku J, Schwab JH: Hepatic inflammation in rats with experimental small intestinal bacterial overgrowth. Gastroenterology 98:414–423, 1990PubMedGoogle Scholar
  24. 24.
    Hocking MP, Duerson MC, O'Leary JP, Woodward ER: Jejunoileal bypass for morbid obesity. Late follow-up in 100 cases. N Engl J Med 308:995–999, 1983PubMedGoogle Scholar
  25. 25.
    Lichtman SN, Keku J, Schwab JH, Sartor RRB: Hepatic injury associated with small bowel bacterial overgrowth in rats is prevented by metronidazole and tetracycline. Gastroenterology 100:513–519, 1991PubMedGoogle Scholar
  26. 26.
    Oelberg DG, Chari MV, Little JM, Adcock EW, Lester R: Lithocholate glucuronide is a cholestatic agent. J Clin Invest 73:1507–1514, 1984PubMedGoogle Scholar
  27. 27.
    Edmiston CE Jr, Condon RE: Bacterial translocation. Surg Gynecol Obstet 173:73–83, 1991PubMedGoogle Scholar
  28. 28.
    Rush BF Jr, Sori AJ, Murphy TF, Smith S, Flanagan JJ Jr, Machiedo GW: Endotoxemia and bacteremia during hemorrhagic shock. The link between trauma and sepsis? Ann Surg 207:549–554, 1988PubMedGoogle Scholar
  29. 29.
    Maejima K, Deitch EA, Berg RD: Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury. Infect Immun 43:6–10, 1984PubMedGoogle Scholar
  30. 30.
    Sorell WT, Quigley EMM, Jin G, Johnson TJ, Rikkers LF: Bacterial translocation in the portal-hypertensive rat: Studies in basal conditions and on exposure to hemorrhagic shock. Gastroenterology 104:1722–1726, 1993PubMedGoogle Scholar
  31. 31.
    Garcia-Tsao G, Albillos A, arden GE, West B: Bacterial translocation in acute and chronic portal hypertension. Hepatology 17:1081–1085, 1993PubMedGoogle Scholar
  32. 32.
    Llovet JM, Bartoli R, Planas R, Arnal J, Cabre E, Urban A: Relación de la traslocación bacteriana (TB) con la peritonitis bacteriana espontánea (PE) en ratas cirróticas. Gastroenterol Hepatol 16:269–270, 1993 (abstract)Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • F. Casafont Morencos
    • 1
  • G. de las Heras Castano
    • 1
  • L. Martín Ramos
    • 1
  • Maria J. López Arias
    • 1
  • F. Ledesma
    • 1
  • F. Pons Romero
    • 1
  1. 1.From the Department of GastroenterologyHospital Universitario Marqués de ValdecillaSantanderSpain

Personalised recommendations