Hydrogen-producing small intestinal bacterial overgrowth is associated with hepatic encephalopathy and liver function

• Published in: PloS one Vol. 17; no. 2; p. e0264459
• Main Authors: Yokoyama, Kunihiko, Sakamaki, Akira, Takahashi, Kazuya, Naruse, Takumi, Sato, Chihiro, Kawata, Yuzo, Tominaga, Kentaro, Abe, Hiroyuki, Sato, Hiroki, Tsuchiya, Atsunori, Kamimura, Kenya, Takamura, Masaaki, Yokoyama, Junji, Terai, Shuji
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.02.2022; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotics; Ascites; Bacteria; Biology and Life Sciences; Breath Tests; Care and treatment; Chi-square test; Cirrhosis; Complications; Complications and side effects; Confidence intervals; Diagnosis; Encephalopathy; Female; Gastroenterology; Gastrointestinal Microbiome - drug effects; Hepatic encephalopathy; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - drug therapy; Hepatic Encephalopathy - metabolism; Hepatic Encephalopathy - microbiology; Hepatology; Humans; Hydrogen; Hydrogen - metabolism; Intestine; Intestine, Small - metabolism; Intestine, Small - microbiology; Irritable bowel syndrome; Liver; Liver - metabolism; Liver cancer; Liver cirrhosis; Male; Medical prognosis; Medicine and Health Sciences; Metabolism; Metabolites; Methane; Middle Aged; Patients; Physical Sciences; Prospective Studies; Quality of life; Reclassification; Rifaximin - administration & dosage; Small intestine; Statistical tests; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264459

Overt hepatic encephalopathy (HE) is one of the complications of liver cirrhosis (LC), which negatively affects the prognosis and quality of life of patients. Small intestinal bacterial overgrowth (SIBO) is significantly associated with LC and its complications, including HE. We investigated the relationship between SIBO and LC, and the difference between hydrogen-producing and methane-producing SIBO (H-SIBO and M-SIBO, respectively). This is a prospective cohort study of 107 cases. Breath measurements of hydrogen and methane concentrations were performed for the diagnosis of SIBO. The study cohort included 81 males with a median age of 70 (40-86) years, and SIBO was detected in 31 cases (29.0%). There were no significant differences between the SIBO positive and SIBO negative groups. Reclassification into H-SIBO (16 cases) and others (91 cases) was performed, and the Child-Pugh score was only derived in the multivariate logistic analysis (P = 0.028, odds ratio 1.39, 95% confidence interval 1.04-1.85). Furthermore, H-SIBO was significantly associated with covert HE in chi-square test (50.0% vs. 24.2%, P = 0.034). In addition, we evaluated the therapeutic response on SIBO of rifaximin in eight covert HE patients. 20% patients with M-SIBO and 67% patients with H-SIBO showed an improvement of the breath test. In conclusion, H-SIBO, but not M-SIBO, is significantly associated with liver function, and rifaximin might be more effective for covert HE with H-SIBO. Therefore, the diagnosis of SIBO, including the classification as H-SIBO and M-SIBO, might help to determine the choice of treatment for HE.