Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy
Background We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared...
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| Veröffentlicht in: | International journal of clinical practice (Esher) 2021-04, Vol.75 (4), p.e13947-n/a |
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| creator | Mikolasevic, Ivana Delija, Bozena Mijic, Ana Stevanovic, Tajana Skenderevic, Nadija Sosa, Ivan Krznaric‐Zrnic, Irena Abram, Maja Krznaric, Zeljko Domislovic, Viktor Filipec Kanizaj, Tajana Radic‐Kristo, Delfa Cubranic, Aleksandar Grubesic, Aron Nakov, Radislav Skrobonja, Ivana Stimac, Davor Hauser, Goran |
| description | Background
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non‐significant or no liver fibrosis.
Methods
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results
Patients with non‐alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P |
| doi_str_mv | 10.1111/ijcp.13947 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2476126050</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2476126050</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4597-94c143244860e72099e900dac12b7cd44f8342583261ea2a2e2dfa9fbbe018413</originalsourceid><addsrcrecordid>eNp9kc1qFEEQxxsxmLh68QGkwYsIE_trvo6yaEwIRFDPQ01PzW4vvd1jd2_C3CRP4DP6JHYyiQcP1qXq8KsfVP0JecXZKc_13uz0dMplq-on5ITXShRcKP40z7JqipJJfkyex7hjTJRlw56RYykVq0RTnZDbr3uwlhqXMCbjwNIedMJg8uSvMWyCv0lbCm6gzrvfP3-B1X7rrdF0hJRmak2m6GAiQsTcYeN8xIH2M00BXDToEkULMflNgGk737uWrd74Kc4vyNEINuLLh74i3z99_Lb-XFxenZ2vP1wWWpVtXbRKcyWFUk3FsBasbbFlbADNRV_rQamxkUqUjRQVRxAgUAwjtGPfI-ON4nJF3i7eKfgfh3xutzdRo7Xg0B9iJ1RdcVGx_LAVefMPuvOHkL-TqZK1QoqmFJl6t1A6-BgDjt0UzB7C3HHW3SXT3SXT3SeT4dcPykO_x-Ev-hhFBvgC3BiL839U3fnF-ssi_QPH_Jtc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2509232852</pqid></control><display><type>article</type><title>Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Mikolasevic, Ivana ; Delija, Bozena ; Mijic, Ana ; Stevanovic, Tajana ; Skenderevic, Nadija ; Sosa, Ivan ; Krznaric‐Zrnic, Irena ; Abram, Maja ; Krznaric, Zeljko ; Domislovic, Viktor ; Filipec Kanizaj, Tajana ; Radic‐Kristo, Delfa ; Cubranic, Aleksandar ; Grubesic, Aron ; Nakov, Radislav ; Skrobonja, Ivana ; Stimac, Davor ; Hauser, Goran</creator><creatorcontrib>Mikolasevic, Ivana ; Delija, Bozena ; Mijic, Ana ; Stevanovic, Tajana ; Skenderevic, Nadija ; Sosa, Ivan ; Krznaric‐Zrnic, Irena ; Abram, Maja ; Krznaric, Zeljko ; Domislovic, Viktor ; Filipec Kanizaj, Tajana ; Radic‐Kristo, Delfa ; Cubranic, Aleksandar ; Grubesic, Aron ; Nakov, Radislav ; Skrobonja, Ivana ; Stimac, Davor ; Hauser, Goran</creatorcontrib><description>Background
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non‐significant or no liver fibrosis.
Methods
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results
Patients with non‐alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07‐37.37), 2.50 (1.16‐5.37) and 27.6 (6.41‐119), respectively). The most commonly isolated were gram‐negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae.
Conclusion
In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well‐investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.</description><identifier>ISSN: 1368-5031</identifier><identifier>EISSN: 1742-1241</identifier><identifier>DOI: 10.1111/ijcp.13947</identifier><identifier>PMID: 33406286</identifier><language>eng</language><publisher>England: Hindawi Limited</publisher><subject>Biopsy ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 ; Duodenum ; Elasticity Imaging Techniques ; Fatty liver ; Fibrosis ; Gram-negative bacteria ; Humans ; Inflammation ; Intestine ; Liver - diagnostic imaging ; Liver Cirrhosis ; Liver diseases ; Multivariate analysis ; Non-alcoholic Fatty Liver Disease - complications ; Small intestine ; Steatosis</subject><ispartof>International journal of clinical practice (Esher), 2021-04, Vol.75 (4), p.e13947-n/a</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4597-94c143244860e72099e900dac12b7cd44f8342583261ea2a2e2dfa9fbbe018413</citedby><cites>FETCH-LOGICAL-c4597-94c143244860e72099e900dac12b7cd44f8342583261ea2a2e2dfa9fbbe018413</cites><orcidid>0000-0001-9676-0642</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fijcp.13947$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fijcp.13947$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33406286$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mikolasevic, Ivana</creatorcontrib><creatorcontrib>Delija, Bozena</creatorcontrib><creatorcontrib>Mijic, Ana</creatorcontrib><creatorcontrib>Stevanovic, Tajana</creatorcontrib><creatorcontrib>Skenderevic, Nadija</creatorcontrib><creatorcontrib>Sosa, Ivan</creatorcontrib><creatorcontrib>Krznaric‐Zrnic, Irena</creatorcontrib><creatorcontrib>Abram, Maja</creatorcontrib><creatorcontrib>Krznaric, Zeljko</creatorcontrib><creatorcontrib>Domislovic, Viktor</creatorcontrib><creatorcontrib>Filipec Kanizaj, Tajana</creatorcontrib><creatorcontrib>Radic‐Kristo, Delfa</creatorcontrib><creatorcontrib>Cubranic, Aleksandar</creatorcontrib><creatorcontrib>Grubesic, Aron</creatorcontrib><creatorcontrib>Nakov, Radislav</creatorcontrib><creatorcontrib>Skrobonja, Ivana</creatorcontrib><creatorcontrib>Stimac, Davor</creatorcontrib><creatorcontrib>Hauser, Goran</creatorcontrib><title>Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy</title><title>International journal of clinical practice (Esher)</title><addtitle>Int J Clin Pract</addtitle><description>Background
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non‐significant or no liver fibrosis.
Methods
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results
Patients with non‐alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07‐37.37), 2.50 (1.16‐5.37) and 27.6 (6.41‐119), respectively). The most commonly isolated were gram‐negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae.
Conclusion
In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well‐investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.</description><subject>Biopsy</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2</subject><subject>Duodenum</subject><subject>Elasticity Imaging Techniques</subject><subject>Fatty liver</subject><subject>Fibrosis</subject><subject>Gram-negative bacteria</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Intestine</subject><subject>Liver - diagnostic imaging</subject><subject>Liver Cirrhosis</subject><subject>Liver diseases</subject><subject>Multivariate analysis</subject><subject>Non-alcoholic Fatty Liver Disease - complications</subject><subject>Small intestine</subject><subject>Steatosis</subject><issn>1368-5031</issn><issn>1742-1241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1qFEEQxxsxmLh68QGkwYsIE_trvo6yaEwIRFDPQ01PzW4vvd1jd2_C3CRP4DP6JHYyiQcP1qXq8KsfVP0JecXZKc_13uz0dMplq-on5ITXShRcKP40z7JqipJJfkyex7hjTJRlw56RYykVq0RTnZDbr3uwlhqXMCbjwNIedMJg8uSvMWyCv0lbCm6gzrvfP3-B1X7rrdF0hJRmak2m6GAiQsTcYeN8xIH2M00BXDToEkULMflNgGk737uWrd74Kc4vyNEINuLLh74i3z99_Lb-XFxenZ2vP1wWWpVtXbRKcyWFUk3FsBasbbFlbADNRV_rQamxkUqUjRQVRxAgUAwjtGPfI-ON4nJF3i7eKfgfh3xutzdRo7Xg0B9iJ1RdcVGx_LAVefMPuvOHkL-TqZK1QoqmFJl6t1A6-BgDjt0UzB7C3HHW3SXT3SXT3SeT4dcPykO_x-Ev-hhFBvgC3BiL839U3fnF-ssi_QPH_Jtc</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Mikolasevic, Ivana</creator><creator>Delija, Bozena</creator><creator>Mijic, Ana</creator><creator>Stevanovic, Tajana</creator><creator>Skenderevic, Nadija</creator><creator>Sosa, Ivan</creator><creator>Krznaric‐Zrnic, Irena</creator><creator>Abram, Maja</creator><creator>Krznaric, Zeljko</creator><creator>Domislovic, Viktor</creator><creator>Filipec Kanizaj, Tajana</creator><creator>Radic‐Kristo, Delfa</creator><creator>Cubranic, Aleksandar</creator><creator>Grubesic, Aron</creator><creator>Nakov, Radislav</creator><creator>Skrobonja, Ivana</creator><creator>Stimac, Davor</creator><creator>Hauser, Goran</creator><general>Hindawi Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TK</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9676-0642</orcidid></search><sort><creationdate>202104</creationdate><title>Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy</title><author>Mikolasevic, Ivana ; Delija, Bozena ; Mijic, Ana ; Stevanovic, Tajana ; Skenderevic, Nadija ; Sosa, Ivan ; Krznaric‐Zrnic, Irena ; Abram, Maja ; Krznaric, Zeljko ; Domislovic, Viktor ; Filipec Kanizaj, Tajana ; Radic‐Kristo, Delfa ; Cubranic, Aleksandar ; Grubesic, Aron ; Nakov, Radislav ; Skrobonja, Ivana ; Stimac, Davor ; Hauser, Goran</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4597-94c143244860e72099e900dac12b7cd44f8342583261ea2a2e2dfa9fbbe018413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biopsy</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2</topic><topic>Duodenum</topic><topic>Elasticity Imaging Techniques</topic><topic>Fatty liver</topic><topic>Fibrosis</topic><topic>Gram-negative bacteria</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Intestine</topic><topic>Liver - diagnostic imaging</topic><topic>Liver Cirrhosis</topic><topic>Liver diseases</topic><topic>Multivariate analysis</topic><topic>Non-alcoholic Fatty Liver Disease - complications</topic><topic>Small intestine</topic><topic>Steatosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mikolasevic, Ivana</creatorcontrib><creatorcontrib>Delija, Bozena</creatorcontrib><creatorcontrib>Mijic, Ana</creatorcontrib><creatorcontrib>Stevanovic, Tajana</creatorcontrib><creatorcontrib>Skenderevic, Nadija</creatorcontrib><creatorcontrib>Sosa, Ivan</creatorcontrib><creatorcontrib>Krznaric‐Zrnic, Irena</creatorcontrib><creatorcontrib>Abram, Maja</creatorcontrib><creatorcontrib>Krznaric, Zeljko</creatorcontrib><creatorcontrib>Domislovic, Viktor</creatorcontrib><creatorcontrib>Filipec Kanizaj, Tajana</creatorcontrib><creatorcontrib>Radic‐Kristo, Delfa</creatorcontrib><creatorcontrib>Cubranic, Aleksandar</creatorcontrib><creatorcontrib>Grubesic, Aron</creatorcontrib><creatorcontrib>Nakov, Radislav</creatorcontrib><creatorcontrib>Skrobonja, Ivana</creatorcontrib><creatorcontrib>Stimac, Davor</creatorcontrib><creatorcontrib>Hauser, Goran</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of clinical practice (Esher)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mikolasevic, Ivana</au><au>Delija, Bozena</au><au>Mijic, Ana</au><au>Stevanovic, Tajana</au><au>Skenderevic, Nadija</au><au>Sosa, Ivan</au><au>Krznaric‐Zrnic, Irena</au><au>Abram, Maja</au><au>Krznaric, Zeljko</au><au>Domislovic, Viktor</au><au>Filipec Kanizaj, Tajana</au><au>Radic‐Kristo, Delfa</au><au>Cubranic, Aleksandar</au><au>Grubesic, Aron</au><au>Nakov, Radislav</au><au>Skrobonja, Ivana</au><au>Stimac, Davor</au><au>Hauser, Goran</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy</atitle><jtitle>International journal of clinical practice (Esher)</jtitle><addtitle>Int J Clin Pract</addtitle><date>2021-04</date><risdate>2021</risdate><volume>75</volume><issue>4</issue><spage>e13947</spage><epage>n/a</epage><pages>e13947-n/a</pages><issn>1368-5031</issn><eissn>1742-1241</eissn><abstract>Background
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non‐significant or no liver fibrosis.
Methods
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results
Patients with non‐alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07‐37.37), 2.50 (1.16‐5.37) and 27.6 (6.41‐119), respectively). The most commonly isolated were gram‐negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae.
Conclusion
In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well‐investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.</abstract><cop>England</cop><pub>Hindawi Limited</pub><pmid>33406286</pmid><doi>10.1111/ijcp.13947</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-9676-0642</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Biopsy Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 Duodenum Elasticity Imaging Techniques Fatty liver Fibrosis Gram-negative bacteria Humans Inflammation Intestine Liver - diagnostic imaging Liver Cirrhosis Liver diseases Multivariate analysis Non-alcoholic Fatty Liver Disease - complications Small intestine Steatosis |
| title | Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy |
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