Small Intestinal Bacterial Overgrowth in Patients With Severe Alcoholic Hepatitis: Frequency and Predictors

TL;DR

This study found that small intestinal bacterial overgrowth is more common in patients with severe alcoholic hepatitis than in healthy individuals.

Contribution

The study identifies predominant methane producer status as a strong predictor of SIBO in severe alcoholic hepatitis patients.

Findings

SIBO occurred in 25% of SAH patients versus 3.3% of healthy controls.

Predominant methane producer status was a strong independent predictor of SIBO.

Lower globulin and total protein levels were associated with SIBO in univariate analysis.

Abstract

Background and aims: Small intestinal bacterial overgrowth (SIBO) is a gut microbiota-related disorder characterized by excessive bacterial density and/or abnormal microbiota composition in the small intestine. We aimed to evaluate the frequency of SIBO in patients with severe alcoholic hepatitis (SAH) and to identify independent predictors.

Methods: We included 60 consecutive patients with SAH and 30 healthy controls (HC). After an overnight fast, SIBO was evaluated using the glucose hydrogen breath test (GHBT) with 100 g of glucose. A sustained increase in breath hydrogen or methane levels > 12 parts per million (ppm) above the basal level was considered diagnostic for SIBO.

Results: SIBO was more frequent in patients with SAH than HC (15/60 (25.0%) vs. 1/30 (3.3%), p = 0.017). In the univariate analysis, globulin levels, total protein levels, and predominant methane producer status significantly differed between patients with and without SIBO. In the multivariate analysis, the predominant methane producer status increased the risk of SIBO by 17.44 times (adjusted odds ratio: 17.44 (95% CI (1.9-154.04)), p = 0.001).

Conclusions: This study showed that SIBO is a more common finding in patients with SAH than in HC. The predominant methane producer status independently predicted the SIBO in these patients.