Small intestinal bacterial overgrowth and delayed orocecal transit time in patients with cirrhosis and low-grade hepatic encephalopathy.

Abstract

Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Gut-derived nitrogenous substances play a role in pathogenesis of HE. The present study was conducted to assess small intestinal bacterial overgrowth (SIBO) and prolonged orocecal transit time (OCTT) in cirrhosis and low-grade HE. In cross-sectional prospective study, 75 patients were divided into 3 groups: group 1 (no HE, n=31), group 2 (minimal HE, n=29), and group 3 (early/grade 1 HE, n=15). Minimal HE (MHE) was diagnosed when psychometric hepatic encephalopathy score (PHES) was ≤5. Early HE was diagnosed, according to West Haven criteria. All patients underwent glucose hydrogen breath test (GHBT) for SIBO and lactulose hydrogen breath test (LHBT) for OCTT. A total of 29 patients (38.67%) had MHE and 15 (20%) had early HE. Prevalence of MHE in Child-Turcotte-Pugh (CTP) class A, B, and C was 33.3, 38.71, and 45%, respectively, while SIBO was detected in 26 (34.67%). Prevalence of SIBO was 12.5% in CTP class A, 41.94% in CTP class B, and 50% in CTP class C. Five (16.13%) patients in no HE group had SIBO as compared to 14 (48.28%) in MHE group and 7 (46.67%) in early HE group (p=0.018). OCTT was 111.13±13.95min in patients with no HE as compared to 137.59±14.80min in patients with MHE and 150±15.12min in patients with early HE (p<0.001). OCTT was significantly prolonged in patients with SIBO (145±17.49min) than in those without SIBO (120.71±18.3min) (p<0.001). SIBO and delayed OCTT are more common with MHE and early HE in patients with cirrhosis.