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High Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Morbid Obesity: A Contributor to Severe Hepatic Steatosis

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Abstract

Background

With the increasing prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) has become a major cause of liver diseases. Small intestinal bacterial overgrowth (SIBO) could be related to NAFLD. Our aim was to determine the prevalence of SIBO and its relationship with liver lesions in morbidly obese patients.

Methods

A glucose hydrogen (H2) breath test (positive if fasting breath H2 concentration > 20 ppm and/or an increase of > 10 ppm over baseline within the first 2 h) was performed in obese patients referred for bariatric surgery (body mass index [BMI] >  40 kg/m2 or >  35 in association with comorbidities) and in healthy non-obese subjects. In obese patients, a surgical liver biopsy was performed.

Results

One hundred and forty-six patients (129 women, age [mean±SE]: 40.7 ± 11.4 years) were prospectively included in the study. The mean BMI was 46.1±6.4 kg/m2. A liver biopsy was available in 137 patients and a breath test in 136. The frequency of positive breath tests was higher in obese patients (24/136, 17.1%) than in healthy subjects (1/40, 2.5%; P=0.031). In the univariate analysis, SIBO was not associated with clinical variables, but tended to be associated with more frequent severe hepatic steatosis (26.3 vs. 10.3%, P=0.127), whereas the frequency of sinusoidal or portal fibrosis, lobular necrosis and non-alcoholic steatohepatitis (NASH) were not different. In the multivariate analysis, SIBO (P=0.005) and the presence of a metabolic syndrome (P=0.006) were independent factors of severe hepatic steatosis.

Conclusion

In morbidly obese patients, bacterial overgrowth prevalence is higher than in healthy subjects and is associated with severe hepatic steatosis.

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Abbreviations

BMI:

Body mass index

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

SIBO:

Small intestinal bacterial overgrowth

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Authors and Affiliations

  1. Service d’Hépato-Gastroentérologie, AP-HP, Hôpital Louis Mourier, Université Paris 7, 92700, Colombes, France

    Jean-Marc Sabaté, Pauline Jouët, Florence Harnois & Benoît Coffin

  2. Service d’Anatomo-Pathologie, AP-HP, Hôpital Louis Mourier, Université Paris 7, 92700, Colombes, France

    Charlotte Mechler & Maggy Grossin

  3. Service de Chirurgie, AP-HP, Hôpital Louis Mourier, Université Paris 7, 92700, Colombes, France

    Simon Msika

  4. Service d’Hépato-Gastroentérologie, AP-HP Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes CEDEX, France

    Jean-Marc Sabaté

Authors
  1. Jean-Marc Sabaté
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  2. Pauline Jouët
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  4. Charlotte Mechler
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Correspondence to Jean-Marc Sabaté.

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Sabaté, JM., Jouët, P., Harnois, F. et al. High Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Morbid Obesity: A Contributor to Severe Hepatic Steatosis. OBES SURG 18, 371–377 (2008). https://doi.org/10.1007/s11695-007-9398-2

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  • DOI: https://doi.org/10.1007/s11695-007-9398-2

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