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Small intestinal bacterial overgrowth and non‐alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy

2021; Wiley; Volume: 75; Issue: 4 Linguagem: Inglês

10.1111/ijcp.13947

1742-1241

Ivana Mikolašević, Božena Delija, Ana Mijić, Tajana Stevanović, Nadija Skenderević, Ivan Šoša, Irena Krznarić Zrnić, Maja Abram, Željko Krznarić, Viktor Domislović, Tajana Filipec Kanižaj, Delfa Radić-Krišto, Aleksandar Čubranić, Aron Grubešić, Radislav Nakov, Ivana Škrobonja, Davor Štimac, Goran Hauser,

Liver Disease and Transplantation

International Journal of Clinical PracticeVolume 75, Issue 4 e13947 ORIGINAL PAPER Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy Ivana Mikolasevic, Corresponding Author ivana.mikolasevic@gmail.com orcid.org/0000-0001-9676-0642 Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, Croatia Department of Gastroenterology, UH Merkur, Zagreb, Croatia Correspondence Ivana Mikolasevic, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia. Email: ivana.mikolasevic@gmail.comSearch for more papers by this authorBozena Delija, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorAna Mijic, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorTajana Stevanovic, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorNadija Skenderevic, Department of Gastroenterology, UH Merkur, Zagreb, CroatiaSearch for more papers by this authorIvan Sosa, Department of Forensic Medicine and Criminalistics, University of Rijeka Faculty of Medicine, Rijeka, CroatiaSearch for more papers by this authorIrena Krznaric-Zrnic, Department of Gastroenterology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorMaja Abram, Faculty of Medicine, University of Rijeka, Rijeka, Croatia Department of Clinical Microbiology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorZeljko Krznaric, Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia Faculty of Medicine, UHC Zagreb, Zagreb, CroatiaSearch for more papers by this authorViktor Domislovic, Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, CroatiaSearch for more papers by this authorTajana Filipec Kanizaj, Department of Gastroenterology, UH Merkur, Zagreb, Croatia Faculty of Medicine, UHC Zagreb, Zagreb, CroatiaSearch for more papers by this authorDelfa Radic-Kristo, Faculty of Medicine, UHC Zagreb, Zagreb, Croatia Department of Hematology, UH Merkur, Zagreb, CroatiaSearch for more papers by this authorAleksandar Cubranic, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorAron Grubesic, Faculty of Medicine, University of Rijeka, Rijeka, Croatia Department of Hematology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorRadislav Nakov, Queen Yoanna University Hospital, Medical University of Sofia, Sofia, BulgariaSearch for more papers by this authorIvana Skrobonja, Department of Clinical Microbiology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorDavor Stimac, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorGoran Hauser, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, Croatia Faculty of Health Studies, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this author Ivana Mikolasevic, Corresponding Author ivana.mikolasevic@gmail.com orcid.org/0000-0001-9676-0642 Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, Croatia Department of Gastroenterology, UH Merkur, Zagreb, Croatia Correspondence Ivana Mikolasevic, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia. Email: ivana.mikolasevic@gmail.comSearch for more papers by this authorBozena Delija, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorAna Mijic, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorTajana Stevanovic, Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorNadija Skenderevic, Department of Gastroenterology, UH Merkur, Zagreb, CroatiaSearch for more papers by this authorIvan Sosa, Department of Forensic Medicine and Criminalistics, University of Rijeka Faculty of Medicine, Rijeka, CroatiaSearch for more papers by this authorIrena Krznaric-Zrnic, Department of Gastroenterology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorMaja Abram, Faculty of Medicine, University of Rijeka, Rijeka, Croatia Department of Clinical Microbiology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorZeljko Krznaric, Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, Croatia Faculty of Medicine, UHC Zagreb, Zagreb, CroatiaSearch for more papers by this authorViktor Domislovic, Department of Gastroenterology and Hepatology, UHC Zagreb, Zagreb, CroatiaSearch for more papers by this authorTajana Filipec Kanizaj, Department of Gastroenterology, UH Merkur, Zagreb, Croatia Faculty of Medicine, UHC Zagreb, Zagreb, CroatiaSearch for more papers by this authorDelfa Radic-Kristo, Faculty of Medicine, UHC Zagreb, Zagreb, Croatia Department of Hematology, UH Merkur, Zagreb, CroatiaSearch for more papers by this authorAleksandar Cubranic, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorAron Grubesic, Faculty of Medicine, University of Rijeka, Rijeka, Croatia Department of Hematology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorRadislav Nakov, Queen Yoanna University Hospital, Medical University of Sofia, Sofia, BulgariaSearch for more papers by this authorIvana Skrobonja, Department of Clinical Microbiology, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this authorDavor Stimac, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorGoran Hauser, Department of Gastroenterology, UHC Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, Croatia Faculty of Health Studies, UHC Rijeka, Rijeka, CroatiaSearch for more papers by this author First published: 06 January 2021 https://doi.org/10.1111/ijcp.13947Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat 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. Open Research DATA AVAILABILITY STATEMENT Data not available because of ethical restrictions. Volume75, Issue4April 2021e13947 RelatedInformation