Small Intestinal Bacterial Overgrowth in Patients with Severe Alcoholic Hepatitis

Background and Aim: Alcohol consumption and liver cirrhosis are important causes of alterations in the quantity and quality of the gut microbiota. The presence of small intestinal bacterial overgrowth (SIBO) increases the risk of systemic complications of liver diseases such as hepatic encephalopathy and spontaneous bacterial peritonitis. We aimed to evaluate the frequency of SIBO among patients with severe alcoholic hepatitis (SAH) and identify predictors of SIBO among patients with SAH. Methods: Sixty patients and 30 healthy controls were included in this study. Patients with alcoholic hepatitis with a Maddrey’s discriminant function score of 32 were included. All patients and controls underwent the glucose hydrogen breath test (GHBT) for SIBO. A persistent rise in breath hydrogen or methane levels > 12 parts per million (ppm) above the basal level (at least two readings) was considered diagnostic of SIBO. Patients with basal methane concentrations10 ppm were defined as the predominant methane producers (PMP). Results: The prevalence of SIBO was 25 % among SAH and 3.4 % in healthy controls (p=0.017). On univariate analysis, serum globulin, total protein levels > 7.5 gm%, and basal PMP status significantly differed between the SIBO-positive and SIBO-negative groups (p < 0.05), whereas ascites and a heart rate of more than 90 showed a trend towards significance. The fasting PMP status was the only factor independently associated with SIBO in SAH on multivariate analysis {p = 0.001, Adjusted Odds ratio 17.44; 95 % C.I (1.9“154.04)}. Conclusion: This pioneer study revealed that SIBO was more common in patients with severe alcoholic hepatitis than in healthy controls. Fasting PMP status was an independent risk factor for SIBO in SAH.