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Increased Orocecal Transit Time in Patients with Nonalcoholic Fatty Liver Disease

Digestive Diseases and Sciences volume 50, pages 1136–1140 (2005)Cite this article

Abstract

Intestinal bacterial overgrowth (IBO) has been suggested to play a pathogenic role in patients with nonalcoholic fatty liver disease (NAFLD). Delayed intestinal transit may contribute to IBO development. Ten nondiabetic patients with NAFLD and abnormal liver enzymes were recruited. Ten healthy individuals, matched by sex, age, and body mass index, were used as controls. Orocecal transit time (OCTT) was measured by the lactulose breath test. Anti-endotoxin core antibodies (EndoCAb) were determined. The effect of oral norfloxacin (400 mg BID during 2 weeks) on liver enzymes, lactulose breath test, and EndoCAb was also studied. NAFLD patients had higher basal breathed H2 and prolonged OCTT compared to controls (127 ± 61 vs. 57 ± 23 min, respectively; P = 0.0037). EndoCAb titers were similar in NAFLD patients and controls. Norfloxacin administration had no effect on ALT levels, lactulose breath test, or EndoCAb titers in patients with NAFLD. The present data show evidence of deranged intestinal motility in nondiabetic patients with NAFLD and support the hypothesis that NAFLD could be linked to endotoxin-induced liver damage of intestinal origin.

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Refrences

  1. Harrison SA, Torgerson S, Hayashi PH: The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol 98:2042–2047, 2003

    Article  Google Scholar 

  2. Yu AS, Keeffe EB: Nonalcoholic fatty liver disease. Rev Gastroenterol Disord 2:11–19, 2002

    PubMed  PubMed Central  Google Scholar 

  3. Clark JM, Brancati FL, Diehl AM: Nonalcoholic fatty liver disease. Gastroenterology 122:1649–1657, 2002

    Article  Google Scholar 

  4. Brunt EM: Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 21:3–16, 2001

    CAS  Article  Google Scholar 

  5. Clark JM, Diehl AM: Defining nonalcoholic fatty liver disease: implications for epidemiologic studies. Gastroenterology 124:248–250, 2003

    Article  Google Scholar 

  6. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ: Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116:1413–1419, 1999

    CAS  Article  Google Scholar 

  7. Farrell GC: Is bacterial ash the flash that ignites NASH? Gut 48:148–149, 2001

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG: The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut 48:206–211, 2001

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. Nazim M, Stamp G, Hodgson HJ: Non-alcoholic steatohepatitis associated with small intestinal diverticulosis and bacterial overgrowth. Hepatogastroenterology 36:349–351, 1989

    CAS  PubMed  Google Scholar 

  10. McFarland RJ, Gazet JC, Pilkington TR: A 13-year review of jejunoileal bypass. Br J Surg 72:81–87, 1985

    CAS  Article  PubMed  Google Scholar 

  11. Rhodes JM, Middleton P, Jewell DP: The lactulose hydrogen breath test as a diagnostic test for small-bowel bacterial overgrowth. Scand J Gastroenterol 14:333–336, 1979

    CAS  Article  PubMed  Google Scholar 

  12. Wilberg S, Pieramico O, Malfertheiner P: [The H2-lactulose breath test in the diagnosis of intestinal transit time]. Leber Magen Darm 20:129–137, 1990

    CAS  PubMed  Google Scholar 

  13. Barclay GR: Endogenous endotoxin-core antibody (EndoCAb) as a marker of endotoxin exposure and a prognostic indicator: a review. Prog Clin Biol Res 392:263–272, 1995

    CAS  PubMed  Google Scholar 

  14. Day CP, James OF: Steatohepatitis: A tale of two “hits”? Gastroenterology 114:842–845, 1998

    Article  Google Scholar 

  15. Riordan SM, Duncombe VM, Thomas MC, Nagree A, Bolin TD, McIver CJ, Williams R: Small intestinal bacterial overgrowth, intestinal permeability, and non-alcoholic steatohepatitis. Gut 50:136–138, 2002

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. Romagnuolo J, Schiller D, Bailey RJ: Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. Am J Gastroenterol 97:1113–1126, 2002

    Article  PubMed  Google Scholar 

  17. Cuoco L, Montalto M, Jorizzo RA, Santarelli L, Arancio F, Cammarota G, Gasbarrini G: Eradication of small intestinal bacterial overgrowth and oro-cecal transit in diabetics. Hepatogastroenterology 49:1582–1586, 2002

    PubMed  Google Scholar 

  18. Basilisco G, Camboni G, Bozzani A, Vita P, Doldi S, Bianchi PA: Orocecal transit delay in obese patients. Dig Dis Sci 34:509–512, 1989

    CAS  Article  PubMed  Google Scholar 

  19. Pilotto A, Franceschi M, Del Favero G, Fabrello R, Di Mario F, Valerio G: The effect of aging on oro-cecal transit time in normal subjects and patients with gallstone disease. Aging (Milano) 7:234–237, 1995

    CAS  Google Scholar 

  20. Pardo A, Bartoli R, Lorenzo-Zuniga V, et al.: Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis. Hepatology 31:858–863, 2000

    CAS  Article  Google Scholar 

  21. Madrid AM, Hurtado C, Venegas M, Cumsille F, Defilippi C: Long-Term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function. Am J Gastroenterol 96:1251–1255, 2001

    CAS  Article  PubMed  Google Scholar 

  22. Lichtman SN, Okoruwa EE, Keku J, Schwab JH, Sartor RB: Degradation of endogenous bacterial cell wall polymers by the muralytic enzyme mutanolysin prevents hepatobiliary injury in genetically susceptible rats with experimental intestinal bacterial overgrowth. J Clin Invest 90:1313–1322, 1992

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Li Z, Yang S, Lin H, Huang J, et al.: Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepatology 37:343–350, 2003

    CAS  Article  PubMed  Google Scholar 

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Affiliations

  1. Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile

    Alejandro Soza MD, Arnoldo Riquelme MD, Robinson GonzÁlez MD, Manuel Alvarez MD, Rosa MarÍa PÉrez-ayuso MD, Juan Carlos Glasinovic MD & Marco Arrese MD

  2. Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, 833-0024, Santiago, Chile

    Alejandro Soza MD

Authors
  1. Alejandro Soza MD
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  2. Arnoldo Riquelme MD
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  3. Robinson GonzÁlez MD
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  4. Manuel Alvarez MD
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  5. Rosa MarÍa PÉrez-ayuso MD
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  6. Juan Carlos Glasinovic MD
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  7. Marco Arrese MD
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Corresponding author

Correspondence to Alejandro Soza MD.

Additional information

This work was supported in part by a grant from the Centro de Investigaciones Médicas Pontificia Universidad Católica to A.S. and Fondo Nacional de Ciencia y Tecnología (FONDECYT No. 1020641) to M.A.

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Soza, A., Riquelme, A., GonzÁlez, R. et al. Increased Orocecal Transit Time in Patients with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 50, 1136–1140 (2005). https://doi.org/10.1007/s10620-005-2720-8

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  • DOI: https://doi.org/10.1007/s10620-005-2720-8

Key Words

  • nonalcoholic fatty liver
  • steatohepatitis
  • fatty liver
  • intestinal bacterial overgrowth
  • anti-endotoxin antibodies
  • EndoCAb