Increased Orocecal Transit Time in Patients with Nonalcoholic Fatty Liver Disease (original) (raw)

Abstract

Intestinal bacterial overgrowth (IBO) has been suggested to play a pathogenic role in patients with nonalcoholic fatty liver disease (NAFLD). Delayed intestinal transit may contribute to IBO development. Ten nondiabetic patients with NAFLD and abnormal liver enzymes were recruited. Ten healthy individuals, matched by sex, age, and body mass index, were used as controls. Orocecal transit time (OCTT) was measured by the lactulose breath test. Anti-endotoxin core antibodies (EndoCAb) were determined. The effect of oral norfloxacin (400 mg BID during 2 weeks) on liver enzymes, lactulose breath test, and EndoCAb was also studied. NAFLD patients had higher basal breathed H2 and prolonged OCTT compared to controls (127 ± 61 vs. 57 ± 23 min, respectively; P = 0.0037). EndoCAb titers were similar in NAFLD patients and controls. Norfloxacin administration had no effect on ALT levels, lactulose breath test, or EndoCAb titers in patients with NAFLD. The present data show evidence of deranged intestinal motility in nondiabetic patients with NAFLD and support the hypothesis that NAFLD could be linked to endotoxin-induced liver damage of intestinal origin.

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Refrences

  1. Harrison SA, Torgerson S, Hayashi PH: The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol 98:2042–2047, 2003
    Article PubMed Google Scholar
  2. Yu AS, Keeffe EB: Nonalcoholic fatty liver disease. Rev Gastroenterol Disord 2:11–19, 2002
    PubMed Google Scholar
  3. Clark JM, Brancati FL, Diehl AM: Nonalcoholic fatty liver disease. Gastroenterology 122:1649–1657, 2002
    Article PubMed Google Scholar
  4. Brunt EM: Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis 21:3–16, 2001
    Article CAS PubMed Google Scholar
  5. Clark JM, Diehl AM: Defining nonalcoholic fatty liver disease: implications for epidemiologic studies. Gastroenterology 124:248–250, 2003
    Article PubMed Google Scholar
  6. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ: Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116:1413–1419, 1999
    Article CAS PubMed Google Scholar
  7. Farrell GC: Is bacterial ash the flash that ignites NASH? Gut 48:148–149, 2001
    Article CAS PubMed PubMed Central Google Scholar
  8. Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG: The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut 48:206–211, 2001
    Article CAS PubMed PubMed Central Google Scholar
  9. Nazim M, Stamp G, Hodgson HJ: Non-alcoholic steatohepatitis associated with small intestinal diverticulosis and bacterial overgrowth. Hepatogastroenterology 36:349–351, 1989
    CAS PubMed Google Scholar
  10. McFarland RJ, Gazet JC, Pilkington TR: A 13-year review of jejunoileal bypass. Br J Surg 72:81–87, 1985
    Article CAS PubMed Google Scholar
  11. Rhodes JM, Middleton P, Jewell DP: The lactulose hydrogen breath test as a diagnostic test for small-bowel bacterial overgrowth. Scand J Gastroenterol 14:333–336, 1979
    Article CAS PubMed Google Scholar
  12. Wilberg S, Pieramico O, Malfertheiner P: [The H2-lactulose breath test in the diagnosis of intestinal transit time]. Leber Magen Darm 20:129–137, 1990
    CAS PubMed Google Scholar
  13. Barclay GR: Endogenous endotoxin-core antibody (EndoCAb) as a marker of endotoxin exposure and a prognostic indicator: a review. Prog Clin Biol Res 392:263–272, 1995
    CAS PubMed Google Scholar
  14. Day CP, James OF: Steatohepatitis: A tale of two “hits”? Gastroenterology 114:842–845, 1998
    Article Google Scholar
  15. Riordan SM, Duncombe VM, Thomas MC, Nagree A, Bolin TD, McIver CJ, Williams R: Small intestinal bacterial overgrowth, intestinal permeability, and non-alcoholic steatohepatitis. Gut 50:136–138, 2002
    Article CAS PubMed PubMed Central Google Scholar
  16. Romagnuolo J, Schiller D, Bailey RJ: Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. Am J Gastroenterol 97:1113–1126, 2002
    Article PubMed Google Scholar
  17. Cuoco L, Montalto M, Jorizzo RA, Santarelli L, Arancio F, Cammarota G, Gasbarrini G: Eradication of small intestinal bacterial overgrowth and oro-cecal transit in diabetics. Hepatogastroenterology 49:1582–1586, 2002
    PubMed Google Scholar
  18. Basilisco G, Camboni G, Bozzani A, Vita P, Doldi S, Bianchi PA: Orocecal transit delay in obese patients. Dig Dis Sci 34:509–512, 1989
    Article CAS PubMed Google Scholar
  19. Pilotto A, Franceschi M, Del Favero G, Fabrello R, Di Mario F, Valerio G: The effect of aging on oro-cecal transit time in normal subjects and patients with gallstone disease. Aging (Milano) 7:234–237, 1995
    CAS Google Scholar
  20. Pardo A, Bartoli R, Lorenzo-Zuniga V, et al.: Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis. Hepatology 31:858–863, 2000
    Article CAS PubMed Google Scholar
  21. Madrid AM, Hurtado C, Venegas M, Cumsille F, Defilippi C: Long-Term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function. Am J Gastroenterol 96:1251–1255, 2001
    Article CAS PubMed Google Scholar
  22. Lichtman SN, Okoruwa EE, Keku J, Schwab JH, Sartor RB: Degradation of endogenous bacterial cell wall polymers by the muralytic enzyme mutanolysin prevents hepatobiliary injury in genetically susceptible rats with experimental intestinal bacterial overgrowth. J Clin Invest 90:1313–1322, 1992
    Article CAS PubMed PubMed Central Google Scholar
  23. Li Z, Yang S, Lin H, Huang J, et al.: Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepatology 37:343–350, 2003
    Article CAS PubMed Google Scholar

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Authors and Affiliations

  1. Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
    Alejandro Soza MD, Arnoldo Riquelme MD, Robinson GonzÁlez MD, Manuel Alvarez MD, Rosa MarÍa PÉrez-ayuso MD, Juan Carlos Glasinovic MD & Marco Arrese MD
  2. Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, 833-0024, Santiago, Chile
    Alejandro Soza MD

Authors

  1. Alejandro Soza MD
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  2. Arnoldo Riquelme MD
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  3. Robinson GonzÁlez MD
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  4. Manuel Alvarez MD
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  5. Rosa MarÍa PÉrez-ayuso MD
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  6. Juan Carlos Glasinovic MD
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  7. Marco Arrese MD
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Correspondence toAlejandro Soza MD.

Additional information

This work was supported in part by a grant from the Centro de Investigaciones Médicas Pontificia Universidad Católica to A.S. and Fondo Nacional de Ciencia y Tecnología (FONDECYT No. 1020641) to M.A.

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Soza, A., Riquelme, A., GonzÁlez, R. et al. Increased Orocecal Transit Time in Patients with Nonalcoholic Fatty Liver Disease.Dig Dis Sci 50, 1136–1140 (2005). https://doi.org/10.1007/s10620-005-2720-8

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