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Gut 2001;48:206-211 ( February )

Article

The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha  in the pathogenesis of non-alcoholic steatohepatitis A J Wigga, I C Roberts-Thomsona, R B Dymockb, P J McCarthyc, R H Grosea, A G Cumminsa

a Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia, b Department of Histopathology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia, c Department of Biochemistry, Repatriation General Hospital, Adelaide, South Australia, Australia

Correspondence to: A J Wigg, Unit of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, 5042, South Australia, Australia. alan.wigg{at}flinders.edu.au

Accepted for publication 18 July 2000

BACKGROUND---Small intestinal bacterial overgrowth may contribute to the development of non-alcoholic steatohepatitis, perhaps by increasing intestinal permeability and promoting the absorption of endotoxin or other enteric bacterial products.
AIMS---To investigate the prevalence of small intestinal bacterial overgrowth, increased intestinal permeability, elevated endotoxin, and tumour necrosis factor alpha  (TNF-alpha ) levels in patients with non-alcoholic steatohepatitis and in control subjects.
PATIENTS AND METHODS---Twenty two patients with non-alcoholic steatohepatitis and 23 control subjects were studied. Small intestinal bacterial overgrowth was assessed by a combined 14C-D-xylose and lactulose breath test. Intestinal permeability was assessed by a dual lactulose-rhamnose sugar test. Serum endotoxin levels were determined using the limulus amoebocyte lysate assay and TNF-alpha levels using an ELISA.
RESULTS---Small intestinal bacterial overgrowth was present in 50% of patients with non-alcoholic steatosis and 22% of control subjects (p=0.048). Mean TNF-alpha levels in non-alcoholic steatohepatitis patients and control subjects were 14.2 and 7.5 pg/ml, respectively (p=0.001). Intestinal permeability and serum endotoxin levels were similar in the two groups.
CONCLUSIONS---Patients with non-alcoholic steatohepatitis have a higher prevalence of small intestinal bacterial overgrowth, as assessed by the 14C-D-xylose-lactulose breath test, and higher TNF-alpha levels in comparison with control subjects. This is not accompanied by increased intestinal permeability or elevated endotoxin levels.


Keywords: non-alcoholic steatohepatitis; small intestinal bacterial overgrowth; intestinal permeability; endotoxin; tumour necrosis factor alpha


© 2001 by Gut

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