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 Results: During a mean follow-up of 12 months (range 3–33), 11 patients were prematurely withdrawn from the study without SBP (3 transplantations, 2 lost to follow-up, 6 deaths from hepatorenal syndrome, terminal liver failure, variceal bleeding or septic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.

1.
Toskes PP: Bacterial overgrowth of the gastrointestinal tract. Adv Intern Med 1993;38:387–407.
[PubMed]
2.
Chesta J, Defilippi C, Defilippi C: Abnormalities in proximal small bowel motility in patients with cirrhosis. Hepatology 1993;17:828–832.
[PubMed]
3.
Chang CS, Chen GH, Lien HC, Yeh HZ: Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 1998;28:1187–1190.
[PubMed]
4.
Yang CY, Chang CS, Chen GH: Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests. Scand J Gastroenterol 1998;33:867–871.
[PubMed]
5.
Bauer TM, Schwacha H, Steinbruckner B, Brinkmann FE, Ditzen AK, Kist M, et al: Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: poor performance of the glucose breath hydrogen test. J Hepatol 2000;33:382–366.
[PubMed]
6.
Morencos FC, De Las Heras Castano G, Martin Ramos L, Lopez Arias MJ, Ledesma F, Pons Romero F: Small bowel bacterial overgrowth in patients with alcoholic cirrhosis. Dig Dis Sci 1995;40:1252–1256.
[PubMed]
7.
Caly WR, Strauss E: A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993;18:353–358.
[PubMed]
8.
Tito L, Rimola A, Gines P, Llach J, Arroyo V, Rodes J: Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology 1988;8:27–31.
[PubMed]
9.
Guarner C, Sola R, Soriano G, Andreu M, Novella MT, Vila MC, et al: Risk of a first community-acquired spontaneous bacterial peritonitis in cirrhotics with low ascitic fluid protein levels. Gastroenterology 1999;117:414–419.
[PubMed]
10.
Novella M, Sola R, Soriano G, Andreu M, Gana J, Ortiz J, et al: Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology 1997;25:532–536.
[PubMed]
11.
Wiest R. Garcia-Tsao G: Bacterial translocation in cirrhosis. Hepatology 2005;41:422–433.
[PubMed]
12.
Llovet JM, Bartoli R, March F, Planas R, Vinado B, Cabre E, et al: Translocated intestinal bacteria cause spontaneous bacterial peritonitis in cirrhotic rats: molecular epidemiologic evidence. J Hepatol 1998;28:307–313.
[PubMed]
13.
Guarner C, Runyon BA, Young S, Heck M, Sheikh MY: Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites. J Hepatol 1997;26:1372–1378.
[PubMed]
14.
Garcia TG: Identifying new risk factors for spontaneous bacterial peritonitis: how important is it? Gastroenterology 1999;117:495–499.
[PubMed]
15.
Runyon BA, Squier S, Borzio M: Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis. J Hepatol 1994;21:792–796.
[PubMed]
16.
Ghassemi S, Garcia-Tsao G: Prevention and treatment of infections in patients with cirrhosis. Best Pract Res Clin Gastroenterol 2007;21:77–93.
[PubMed]
17.
Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al: Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000;32:142–153.
[PubMed]
18.
Rosenthal A, Solomons NW: Time-course of cigarette smoke contamination of clinical hydrogen breath-analysis tests. Clin Chem 1983;29:1980–1981.
[PubMed]
19.
Attar A, Flourie B, Rambaud JC, Franchisseur C, Ruszniewski P, Bouhnik Y: Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. Gastroenterology 1999;117:794–797.
[PubMed]
20.
Quigley EMM, Quera R: Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology 2006;130(suppl 1):S78–S90.
21.
Bauer TM, Steinbruckner B, Brinkmann FE, Ditzen AK, Schwacha H, Aponte JJ, et al: Small intestinal bacterial overgrowth in patients with cirrhosis: prevalence and relation with spontaneous bacterial peritonitis. Am J Gastroenterol 2001;96:2962–2967.
[PubMed]
22.
Bouhnik Y, Alain S, Attar A, Flourie B, Raskine L, Sanson-Le Pors MJ, et al: Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol 1999;94:1327–1331.
[PubMed]
23.
King CE, Toskes PP: The use of breath tests in the study of malabsorption. Clin Gastroenterol 1983;12:591–610.
[PubMed]
24.
Simrén M, Stotzer PO: Use and abuse of hydrogen breath tests. Gut 2006;55:297–303.
[PubMed]
25.
Flourie B, Turk J, Lemann M, Florent C, Colimon R, Rambaud JC: Breath hydrogen in bacterial overgrowth. Gastroenterology 1989;96:1225.
[PubMed]
26.
Kerlin P, Wong L: Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 1988;95:982–988.
[PubMed]
27.
Metz G, Gassull MA, Drasar BS, Jenkins DJ, Blendis LM: Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet 1976;1:668–669.
[PubMed]
28.
Loft DE, Riley SA, Marsh MN: Comparative value of tests for small bacterial overgrowth (SIBO) (abstract). Gut 1987;28;1351A.
29.
Madrid AM, Cumsille F, Defilippi C: Altered small bowel motility in patients with liver cirrhosis depends on severity of liver disease. Dig Dis Sci 1997;42:738–742.
[PubMed]
30.
Stanley AJ, Gilmour HM, Ghosh S, Ferguson A, McGilchrist AJ: Transjugular intrahepatic portosystemic shunt as a treatment for protein-losing enteropathy caused by portal hypertension. Gastroenterology 1996;111:1679–1682.
[PubMed]
You do not currently have access to this content.