Small Intestine Dysmotility and Bacterial Overgrowth in Cirrhotic Patients With Spontaneous Bacterial Peritonitis

Abstract

Patients with bacterial overgrowth of the small intestine developed spontaneous bacterial peritonitis (SBP) more frequently than patients without bacterial overgrowth of the small intestine. The objective of this study was to determine whether the incidences of small intestine dysmotility and bacterial overgrowth are higher in cirrhotic patients with a history of SBP than in cirrhotic patients without SBP. Forty cirrhotic patients were enrolled in this study. There were 20 patients with a history of SBP and 20 patients without a history of SBP. Small intestine bacterial overgrowth was diagnosed by breath hydrogen test. Small intestine motility was recorded, by a 3–channel solid–state manometric catheter, for 24 hours. There were no statistical differences in age or sex between the two groups. The Child–Pugh scores in the SBP group were higher than in the non–SBP group (10.5 ± 2.1 vs. 8.1 ± 1.9, P< .01). The incidence of bacterial overgrowth of the small intestine was higher in the SBP group than in the non–SBP group (70% vs. 20%, P < .01). The amplitude and duration of migrating motor complex (MMC) activity fronts, as well as the number of clusters per hour, were similar in both groups. However, the frequency of MMC activity fronts was higher in the non–SBP group than in the SBP group (4.8 ± 2.3/24 hours vs. 3.5 ± 1.2/24 hours, P < .05). In addition, the MMC velocity was significantly higher in the non–SBP group (8.3 ± 2.6 vs. 5.3 ± 2.1 cm/min, P < .01). The incidence of bacterial overgrowth of the small intestine was higher in cirrhotic patients with history of SBP than in those without SBP. Small intestine motility dysfunction was more severe in cirrhotic patients with history of SBP. Impaired motility of the small intestine, causing bacterial overgrowth of the small intestine, may be one of the explanations for recurrent SBP in cirrhotic patients.