ASSOCIATION OF INTESTINAL BACTERIAL OVERGROWTH AND DISEASES OF HEPATOBIARY TRACT

Abstract

The aim. Find out the nature of the changes of the hepatobiliary system in patients with intestinal bacterial overgrowth and study the possible mechanisms of their association.Materials and methods. 148 patients with intestinal bacterial overgrowth and intestinal dysbiosis were examined. The level of total cholesterol, cholestasis and cytolysis markers was determined in the blood using the analyzer «Labsystems» (Finland). Intestinal bacterial overgrowth syndrome was assessed using a hydrogen breath test with lactulose on the LactophaH2 apparatus of AMA (St. Petersburg). Intestinal dysbiosis was determined by plating feces on nutrient media. Bile acids in bile were determined on the AmazonX mass spectrometer (Bruker Daltonik GmbH, Bremen, Germany). Ultrasound examination of the abdominal cavity performed with the apparatus «SHIMADZU SDN-500» (Japan). Liver elastography was performed using the AIXPLORER apparatus (France).Results. The syndrome of intestinal bacterial overgrowth in 67% of cases was established in the presence of ileocecal insufficiency, in 33% of cases — with preserved ileocecal function. The combination of intestinal bacterial overgrowth syndrome and intestinal dysbiosis was detected in 81,8% of patients. The majority of the examined patients showed clinical symptoms of damage the hepatobiliary system and intestines, which was confirmed by change laboratory parameters — increase the level of total cholesterol, markers of cholestasis and cytolysis compared with the control group. In the study of bile acids in bile, decrease free (mainlycholic) and increase conjugated (glycodesoxycholic, taurodesoxycholic, glycocholic, taurocholic) bile acids was observed compared with the control group. In general, patients with the syndrome of intestinal bacterial overgrowth revealed the presence of non-calculous cholecystitis — in 11,5% of cases, I stage of cholelithiasis — in 25,7%, II stage of cholelithiasis — in 18,9%, non-alcoholic fatty liver disease on stage steatosis and steatohepatitis — in 43,9% of cases.Conclusion. Intestinal bacterial overgrowth syndrome is the beginning of bacterial translocation, which is the triggering factor in inflammation of the liver and biliary tract. In turn, diseases of the hepatobiliary system contribute to the development of intestinal dysbiosis by reducing the synthesis of bile acids with antibacterial action, as well as violations of their excretion. Thus, strong association of intestinal bacterial overgrowth syndrome with damage to the hepatobiliary system has been established.

Keywords

• bacterial overgrowth syndrome
• dysbiosis
• cholelithiasis
• non-alcoholic fatty liver disease
• bile acids