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.
Similar content being viewed by others
References
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, 1990
Deitch EA, Berg R: Bacterial translocation from the gut: A mechanism of infection. J Burn Care Rehab 8:475–482, 1987
Bode J, Bode C, Heidelbach R, Durr HK, Martini GA: Jejunal microflora in patients with chronic alcohol abuse. Hepatogastroenterol 31:30–34, 1984
Lembcke B, Kraus B, Lankish PG: Small intestinal function in chronic relapsing pancreatitis. Hepatogastroenterology 32:149–151, 1985
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)
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, 1977
Baraona E, Julkunen R, Tannenbaum L, Lieber CS: Role of intestinal bacterial overgrowth in ethanol production and metabolism in rats. Gastroenterology 90:13–100, 1986
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, 1973
Kerlin P, Wong L: Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 95:982–988, 1988
Isaacs PET, Kim YS: The contaminated small bowel syndrome. Am J Med 67:1049–1057, 1979
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, 1990
Metz G, Gassull MA, Drasar BS, Jenkins DJA, Blendis LM: Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet 1:668–669, 1976
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, 1991
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, 1989
Reilly JA Jr, Quigley EMM, Forst CF, Rikkers LF: Small intestinal transit in the portal hypertensive rat. Gastroenterology 100:6700–674, 1991
Granger DN, Barrowman JA: Microcirculation of the alimentary tract. II. Pathophysiology of edema. Gastroenterology 84:1035–1039, 1983
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)
Inou F, Frank GB: Effects of ethyl alcohol on excitability and on neuromuscular transmission in frog skeletal muscle. Br J Pharmacol Chemother 30:186–193, 1967
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, 1989
Caly WR, Strauss E: A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 18:353–358, 1993
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, 1990
Kirsch M: Bacterial overgrowth. Am J Gastroenterol 85:231–237, 1990
Lichtman SN, Sartor RB, Keku J, Schwab JH: Hepatic inflammation in rats with experimental small intestinal bacterial overgrowth. Gastroenterology 98:414–423, 1990
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, 1983
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, 1991
Oelberg DG, Chari MV, Little JM, Adcock EW, Lester R: Lithocholate glucuronide is a cholestatic agent. J Clin Invest 73:1507–1514, 1984
Edmiston CE Jr, Condon RE: Bacterial translocation. Surg Gynecol Obstet 173:73–83, 1991
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, 1988
Maejima K, Deitch EA, Berg RD: Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury. Infect Immun 43:6–10, 1984
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, 1993
Garcia-Tsao G, Albillos A, arden GE, West B: Bacterial translocation in acute and chronic portal hypertension. Hepatology 17:1081–1085, 1993
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)
Author information
Authors and Affiliations
Additional information
This study was supported in part by a grant (No. 91/0675) from Fondo de Investigaciones Sanitarias (FIS), Madrid, Spain.
This article originally appeared inDigestive Diseases and Sciences, Volume 40, Number 6, June 1995, pp. 1252–1256.
Rights and permissions
About this article
Cite this article
Casafont Morencos, F., de Las Heras Castaño, G., Martín Ramos, L. et al. Small bowel bacterial overgrowth in patients with alcoholic cirrhosis. Digest Dis Sci 41, 552–556 (1996). https://doi.org/10.1007/BF02282340
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02282340