Prevalence of Small Bowel Bacterial over Growth (SIBO) in decompensated cirrhosis with portal hypertension: A clinical pilot study

Aims: Decompensated cirrhosis is associated with portal hypertension and its complications, like spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, minimal and overt encephalopathy (HE) that accelerates mortality and affects quality of Life (QOL). Portal hypertension causes transmural edema and Dysbiosis due to altered splanchnic hemodynamics promoting translocation of microbes across the bowel wall causing SBP precipitates HE with substantially reduced survival. This study evaluates the prevalence of SIBO in decompensated cirrhotics without overt HEand recurrence of SBP making challenging clinical course. Methods: Total one hundred and twenty (n=120) patients were recruited. group A-(n=30) healthy controls, group B (n=45) chronic liver disease {(alcohol 12/45(27%) NASH 5/45(11%) HCV 18/45(40%)}, Group C (n=45)- Decompensated Cirrhosis with mean MELD 16. Laboratories studies included, Stool H pylori antigen, ova and parasites, initial lactoferrin, calprotectin, serum ammonia, anti Sacromycescervecesiae antibody IgA and IgG , tissue trans lutaminaseantiody IgA ,IgG, endomysial antibody IgA IgG , de aminatedgliadine peptide IgG, breath testing for SIBO lactose, at base line and after three months. Group C underwent Sonogram guided baseline paracentesis with repeat in three months to evaluate recurrence of SBP in SIBO. Exclusion: Diabetes, renal failure, IBS, celiac, IBD, parkinsonism, idiopathic dysmotility disorders, hepatic encephalopathy, TIPS and drugs-Gut specific Antibiotics, anticholinergics, Tricyclics, Methadone, Narcotics and PPi's. Results:Group A 2/30(6%) positive for SIBO in breath test, 1/30(3%) ASCA IgA. Group B 5/45(11%) positive breath test, 4/45(8%) ASCA IgA. Group C: 33/45(73%) positive Breath test and 38/45 (84%) ASCA IgA. Recurrence of SBO 28/33(85%). Conclusion: This observational clinical trial reveals SIBO is associated with decompensated Cirrhosis. SBP with SIBO has independent morbidity with recurrence Prophylactic antibiotics should be considered to avoid recurrent SBP and Encephalopathy in Cirrhotics with SIBO. Larger study needs to validate the role of SIBO in decompensated cirrhotics with portal hypertension.