Journal of Hepatology
Volume 33, Issue 3 , Pages 382-386 , September 2000

Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: poor performance of the glucose breath hydrogen test

  • Tilman M Bauer

      Affiliations

    • Corresponding Author InformationTilman M. Bauer, Department of Internal Medicine, University Hospital, Hugstetterstr. 55, 79106 Freiburg, Germany. Fax: +49-761-270 3610.
    • Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal MedicineGermany
  • ,
  • Henning Schwacha

      Affiliations

    • Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal MedicineGermany
  • ,
  • Bernhard Steinbrückner

      Affiliations

    • Institute of Medical Microbiology and Hygiene, University Hospital, Freiburg, Germany
  • ,
  • Folke E Brinkmann

      Affiliations

    • Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal MedicineGermany
    • Institute of Medical Microbiology and Hygiene, University Hospital, Freiburg, Germany
  • ,
  • Anette K Ditzen

      Affiliations

    • Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal MedicineGermany
    • Institute of Medical Microbiology and Hygiene, University Hospital, Freiburg, Germany
  • ,
  • Manfred Kist

      Affiliations

    • Institute of Medical Microbiology and Hygiene, University Hospital, Freiburg, Germany
  • ,
  • Hubert E Blum

      Affiliations

    • Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal MedicineGermany

Received 19 July 1999 ,Revised 19 January 2000 ,Accepted 26 February 2000.

References 

  1. Hoefert B. Über die Bakterienbefunde im Duodenalsaft von Gesunden und Kranken. Zschr Klin Med. 1921;92:221–235
  2. Quigley EMM. Gastrointestinal dysfunction in liver disease and portal hypertension. Gut-liver interactions revisited. Dig Dis Sci. 1996;41:557–561
  3. 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
  4. 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 epidemiological evidence. J Hepatol. 1998;28:307–313
  5. Grimm I, Shaheen N. Small bowel bacterial overgrowth: epiphenomenon or bad actor in cirrhosis?. Gastroenterology. 1996;110:955–956
  6. Metz G, Gassull MA, Drasar BS, Jenkins DJ, Blendis LM. Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet. 1976;i:668–669
  7. Casafont Morencos F, 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. 1996;41:552–556
  8. 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
  9. Yang CY, Chang CS, Chen GH. Small-intestinal bacterial over-growth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests. Scand J Gastroenterol. 1998;33:867–871
  10. Shindo K, Machida M, Miyakawa K, Fukumura M. A syndrome of cirrhosis, achlorhydria, small intestinal bacterial overgrowth, and fat malabsorption. Am J Gastroenterol. 1993;88:2084–2091
  11. Norby Rasmussen S, Haagen Nielsen O, Jacobsen IE, Lave J, Justesen T. Tube for sampling of uncontaminated small-bowel juice. Scand J Gastroenterol. 1983;18:359–363
  12. In:  Murray PR,  Baron EJ,  Pfaller MA,  Tenover FC,  Yolken RH editor. Manual of Clinical Microbiology. 6th ed.. Washington: ASM Press; 1995;
  13. Drasar BS, Shiner M, McLeod GM. Studies on the intestinal flora. I. The bacterial flora of the gastrointestinal tract in healthy and achlorhydric persons. Gastroenterology. 1969;56:71–79
  14. Justesen T, Nielsen OH, Jacobsen IE, Lave J, Rasmussen SN. The normal cultivable microflora in upper jejunal fluid in healthy adults. Scand J Gastroenterol. 1984;19:279–282
  15. Anderson IH, Levine AS, Levitt MD. Incomplete absorption of the carbohydrate in all-purpose wheat flour. N Engl J Med. 1981;304:891–892
  16. Thompson DG, Binfield P, De Belder A, O'Brien J, Warren S, Wilson M. Extra intestinal influences on exhaled breath hydrogen measurements during the investigation of gastrointestinal disease. Gut. 1985;26:1349–1352
  17. Fried M, Siegrist H, Frei R, Froehlich F, Duroux P, Thorens J, et al.  Duodenal bacterial overgrowth during treatment in outpatients with omeprazole. Gut. 1994;35:23–26
  18. Shindo K, Yamazaki R, Koide K, Fukumura M, Hirai Y. Alteration of bile acid metabolism by cimetidine in healthy humans. J Invest Med. 1996;44:462–469
  19. Chesta J, Defilippi C. Abnormalities in proximal small bowel motility in patients with cirrhosis. Hepatology. 1993;17:828–832
  20. Viggiano TR, Gostout CJ. Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features. Am J Gastroenterol. 1992;87:944–954
  21. Triger DR. Endotoxemia in liver disease - time for re-appraisal?. J Hepatol. 1991;12:136–138
  22. Lichtman SN, Keku J, Schwab JH, Sartor RB. Hepatic injury associated with small bowel bacterial overgrowth in rats is prevented by metronidazole and tetracycline. Gastroenterology. 1991;100:513–519
  23. King CE, Toskes PP. Comparison of the 1-gram [14C]xylose, 10-gram lactulose-H2, and 80-gram glucose-H2 breath tests in patients with small intestine bacterial overgrowth. Gastroenterology. 1986;91:1447–1451
  24. Corazza GR, Menozzi MG, Strocchi A, Rasciti L, Vaira D, Lecchini R, et al.  The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology. 1990;98:302–309
  25. O'Connor MP, Healy M, Kehely A, Keane CT, O'Moore RR, Weir DG. H2- or C14-breath tests in the diagnosis of small intestinal bacterial overgrowth. Gastroenterology. 1987;92:1557
  26. Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology. 1988;95:982–988
  27. Kaye E, Lim SG, Taylor M, Patel S, Gillespie S, Black CM. Small bowel bacterial overgrowth in systemic sclerosis: detection using direct and indirect methods and treatment outcome. Br J Rheumatol. 1995;34:265–269
  28. Riordan SM, McIver CJ, Bolin TD, Duncombe VM. Fasting breath hydrogen concentrations in gastric and small-intestinal bacterial overgrowth. Scand J Gastroenterol. 1995;30:252–257
  29. Taylor RH, Avgerinos A, Taylor AJ, Hill MJ, Misiewicz JJ. Bacterial colonisation of the jejunum: an evaluation of five diagnostic tests. Gut. 1981;22:442–443
  30. Saltzman JR, Kowdley KV, Pedrosa MC, Sepe T, Golner B, Perrone G, et al.  Bacterial overgrowth without clinical malabsorption in elderly hypochlorhydric subjects. Gastroenterology. 1994;106:615–623
  31. Mac Mahon M, Gibbons N, Mullins E, O'Moore RR, Keane CT, Walsh JB, et al.  Are hydrogen breath tests valid in the elderly?. Gerontology. 1996;42:40–45
  32. Mastropaolo G, Rees WDW. Evaluation of the hydrogen breath test in man: definition and elimination of the early hydrogen peak. Gut. 1987;28:721–725
  33. Perman JA, Modler S, Barr RG, Rosenthal P. Fasting breath hydrogen concentration: normal values and clinical application. Gastroenterology. 1984;87:1358–1363
  34. Corazza GR, Strocchi A, Gasbarrini G. Fasting breath hydrogen in celiac disease. Gastroenterology. 1987;93:53–58
  35. 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
  36. 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
  37. Perman JA, Modler S. Glycoproteins as substrates for production of hydrogen and methane by colonic bacterial flora. Gastroenterology. 1982;83:388–393
  38. Leon-Barua R, Gilman RH, Rodriguez C, Bonilla JJ, Yi A, Maurtua D, et al.  Comparison of three methods to obtain upper small bowel contents for culture. Am J Gastroenterol. 1993;88:925–928
  39. Rumessen JJ, Gudmand-Hoyer E, Bachmann E, Justesen T. Diagnosis of bacterial overgrowth of the small intestine. Comparison of the 14C-D-xylose breath test and jejunal cultures in 60 patients. Scand J Gastroenterol. 1985;20:1267–1275

PII: S0168-8278(00)80273-1

Journal of Hepatology
Volume 33, Issue 3 , Pages 382-386 , September 2000