EFFECT OF SMALL INTESTINAL BACTERIAL OVERGROWTH AND BACTERIAL ENDOTOXEMIA ON THE COURSE OF NONALCOHOLIC FATTY LIVER DISEASE
Aim of investigation: to study the frequency of occurrence of small intestinal bacterial overgrowth (SIBO) and bacterial endotoxemia (BE) in patients with nonalcoholic fatty liver disease (NAFLD) of different stages. Material and methods: The survey included 100 patients (78 (78%) men, 28 (28%) women) with NAFLD of different stages (steatosis - 30 people, nonalcoholic steatohepatitis (NASH) of minimal activity - 30 people, NASH of moderate activity - 30 people, liver cirrhosis - 10 people) at the average age of 51,83±8,48 years old. SIBO was verified by hydrogen breath test with lactulose (LHBT). BE was diagnosed by method of activated particles with the use of test kits of “MAP-Endotox spp.”, Russia. According to the treatment type patients with NAFLD were divided in 3 groups. The first group of 36 people without SIBO (on the background of lifestyle modification) received a 6-month intake of psyllium. The second group of 35 people with SIBO in addition to lifestyle modification received a 7-day course of rifaximi(7 - days/800 mg/d) and psyllium during the period of observation (6 months). Comparison group to assess the prognosis of the disease consisted of 19 patients with NASH who refused therapy at different stages of the investigation. Results: SIBO was detected in 50% patients, including 38% people with recorded BE. In group of steatosis BE rate did not exceed normal values, in NASH groups it increased to 6.67% and 33.33%, respectively, in cirrhosis group - 70%. We analyzed the effectiveness of antibacterial (rifaximin) and prebiotic (psyllium) therapy in the course of 6 months. It is established that control LHBT and MAP-test after 6-months’ observation showed no SIBO and BE in all patients of two groups. The comparison group without therapy aimed at the normalization of intestinal microbiocenosis displayed negative dynamics in the course of the disease. According to the results of the control tests, the frequency of SIBO in this group increased by 20%. Conclusion: 1. Frequency of detection of intestinal microbiocenosis disorders, established by the results of LHBT and MAP-test, increases with the severity of pathological process that testifies the role of microbiota as one of the most important components in development and progression of NAFLD. 2. Combined course therapy of rifaximin and long-term intake of psyllium is effective for correction SIBO and BE as the control tests determine the normalization of their indicators.