A Positive Breath Hydrogen Test Does Not Predict the Occurrence of a Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

Abstract

Background/Aims: A positive breath hydrogen test (BH₂ T) suggesting the presence of a small intestinal bacterial overgrowth (SIBO) might be a factor increasing the risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. In this prospective observational study, we aimed to determine whether a positive BH₂ T was associated in time with the development of SBP in cirrhotics with ascites. Methods: During a 3-year period, we prospectively included 29 consecutive cirrhotics with ascites but without previous episodes of SBP or recent antibiotherapy. Every 3 months or before in the event of cirrhosis complications, patients underwent clinical examination, routine laboratory tests, analysis of ascitic fluid and a BH₂ T after ingestion of 50 g D-glucose. Results: During a mean follow-up of 12 months (range 3–33), 11 patients were prematurely withdrawn from the study without SBP (3 transplantations, 2 lost to follow-up, 6 deaths from hepatorenal syndrome, terminal liver failure, variceal bleeding or septic shock) and 9 developed SBP. In the 29 patients, 116 BH₂ T were performed and were positive 12 times in 8 patients; however, in the same patient the positivity was not constant during the follow-up and not related to the clinical presence of ascites. Among the 9 patients who developed SBP, only 2 had a previous transitory positive BH₂ T, which became negative at least 3 months before the occurrence of SBP. Conclusion: In cirrhotics with ascites the diagnosis of SBP is not associated in time with a recent positive BH₂ T.