Bacterial overgrowth syndrome in patients with chronic diffuse liver diseases depending on the etiology and morphological features

V.I. Didenko, E.V. Zigalo,, Yu.A. Gaidar, V.B. Yagmur


Background. Previous studies have shown an increased risk of liver disease in intestinal dysbiosis. Damage to the liver in itself can be the cause of the bacterial overgrowth syndrome. It has been proven that bacterial overgrowth in the small intestine can play a role in the pathogenesis of alcoholic liver disease and complications associated with chronic hepatitis C. The purpose of the study was to assess the frequency of the small intestinal bacterial overgrowth (SIBO) in patients with chronic diffuse liver diseases (CDLD), depending on the degree of steatosis, the stage of fibrosis, and the activity of the hepatic inflammatory process. Materials and methods. Twenty-seven patients were divided into 2 groups: I — 12 patients with chronic hepatitis associated with the virus C (HCV); II — 15 patients with alcoholic liver disease (ALD) depending on the etiology and progression of steatosis and liver fibrosis using histological methods, computer morphometry, transient elastometry and an indicator of the degree of steatosis CAP using the FibroScan 502. Bacterial overgrowth syndrome was determined using a glucose hydrogen breath test. Results. SIBO was found in 51.8 % of CDLD patients. In patients with ALD, it occurred significantly more often (60.0 %) than in HCV, among which only 41.7 % patients had SIBO. A predominance (70.0 %) of a positive hydrogen breath test was noted in the group with severe steatosis (S3), which significantly distinguished it from the group with initial manifestations of steatosis S1 (37.5 %). In patients with chronic hepatitis C with progressive steatosis, the number of cases of SIBO increases and, conversely, the majority of patients with ALD who had histologically confirmed microvesicular and small-drop fatty liver dystrophy during the hydrogen breath test showed microbiota disturbances in the small intestine. Conclusions. There is a correlation between the indicators of the hydrogen breath test and the histological activity index, histological indicators of the progression of liver steatosis in patients with chronic hepatitis C. Thus, with an increase in the activity of the inflammatory process (9 points) and the degree of liver steatosis (S3), the severity of microbiota disturbances in the small intestine increases (> 20 ppm). The degree of SIBO in HCV reflects the severity of the inflammatory process in the liver.


bacterial overgrowth syndrome; alcoholic liver di­sease, chronic hepatitis C; liver steatosis, liver fibrosis


Non-alcoholic Fatty Liver Disease Study Group, Lonardo A, Bellentani S, et al. Epidemiological modifiers of non–alcoholic fatty liver disease: Focus on highrisk groups. Dig Liver Dis. 2015 Dec;47(12):997-1006. doi: 10.1016/j.dld.2015.08.004.

Stepanov YuM. The use of essential phospholipids for the treatment of fatty liver disease. Gastroenterologìa. 2016;(62):58-63. doi: 10.22141/2308-2097.4.62.2016.81089. (in Russian).

Didenko VI. Recent advances in the assessment of hepatic steatosis. Gastroenterologìa. 2015;(57):94-100. doi: 10.22141/2308-2097.3.57.2015.81530. (in Russian).

Maev IV, Kucheryavyy YuA, Andreev DN, Ivashkina NYu. Small bowel bacterial overgrowth syndrome: clinical relevance, criteria of diagnostics and therapeutic management. Infekcionnye bolezni. 2016;(16):118-125. (in Russian).

Mayevskaya YeA, Cheremushkin SV, Krivoborodova NA, Kucheryavy YuA. Small-intestinal bacterial overgrowth syndrome: from recent scientific data to everyday practice. Kliničeskie perspektivy gastroènterologii, gepatologii. 2013;(5):29-40. (in Russian).

Zharkova MS, Mayevskaya YeA, Ivashkin VT. Influence of the syndrome of excessive bacterial growth and bacterial translocation on the course of the disease in patients with cirrhosis of the liver. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(5):56-63. (in Russian).

Compare D, Coccoli P, Rocco A, et al. Gut-liver axis: the impact of gut microbiota on nonalcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 2012 Jun;22(6):471-6. doi: 10.1016/j.numecd.2012.02.007.

Eremina EYu. Medicines and liver: a constant tandem. Part 1. The Russian Archives of Internal Medicine. 2012;(2):60-64. doi: 10.20514/2226-6704-2012-0-2-60-64. (in Russian).

Sachdev AH, Pimentel M. Gastrointestinal Bacterial Overgrowth Pathogenesis and Clinical Significance. Ther Adv Chronic Dis. 2013 Sep;4(5):223-31. doi: 10.1177/2040622313496126.

Quigley EM. Small intestinal bacterial overgrowth: what it is and what it is not. Curr Opin Gastroenterol. 2014 Mar;30(2):141-6. doi: 10.1097/MOG.0000000000000040.

Claesson MJ, Jeffery IB, Conde S, et al. Gut microbiota composition correlates with diet and health in the elderly. Nature. 2012 Aug 9;488(7410):178-84. doi: 10.1038/nature11319.

Quigley EM, Stanton C, Murphy EF. The gut microbiota and the liver. Pathophysiological and clinical implications. J Hepatol. 2013 May;58(5):1020-7. doi: 10.1016/j.jhep.2012.11.023.

Sapozhnikov AG, Dorosevich AE. Gistologicheskaia i mikroskopicheskaia tekhnika: rukovodstvo [Histological and microscopical technique: a manual]. Smolensk: SAU; 2000. 476 p. (in Russian).

Dontsov DV, Ambalov YuM, Vasileva II. Assessment of the degree of activity of chronic hepatitis C. Modern problems of science and education. 2011;(6):7-18. (in Russian).

Zhdanov KV, Gusev DA, Zacharenko SM, et al. Small intestinal bacterial overgrowth in patients with chronic hepatitis C. Jurnal infektologii. 2011;3(4):98-101. (in Russian).

Ledochowski M. Hydrogen Breath tests. Innsbruck, Austria: Akademie Publishing House; 2008. 20 p.

Gasbarrini A, Corazza GR, Gasbarrini G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009 Mar 30;29 Suppl 1:1-49. doi: 10.1111/j.1365-2036.2009.03951.x.

Rana SV, Malik A. Hydrogen breath tests in gastrointestinal diseases. Indian J Clin Biochem. 2014 Oct;29(4):398-405. doi: 10.1007/s12291-014-0426-4.

De Lédinghen V, Vergniol J, Foucher J, Merrouche W, le Bail B. Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012 Jul;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820.x.

Copyright (c) 2020 V.I. Didenko, E.V. Zigalo,, Yu.A. Gaidar, V.B. Yagmur

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта