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Current Treatment Options in Gastroenterology

Erschienen in:

12.11.2018 | Stomach (P Malfertheiner, Section Editor)

Gastroduodenal “Dysbiosis”: a New Clinical Entity

verfasst von: Ayesha Shah, Mark Morrison, Gerald J Holtmann, MD, PhD, MBA

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 4/2018

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Abstract

Purpose of review

Like the rest of the gastrointestinal tract, the small intestine is colonised by microbes, but how this “microbiome” affects the immune system and digestive functions has largely been overlooked, especially in the “omics” era. Here, we present recent findings that show that the diversity, density and interactions of these microbes in the small intestine can play an important role in the pathogenesis of a number of gastrointestinal and extraintestinal disorders.

Recent findings

Changes in the small intestinal mucosa-associated microbiota (SI-MAM) have been shown to occur with inflammatory bowel diseases, functional gastrointestinal disorders, metabolic disorders such as obesity and type 2 diabetes. More recently, there is emerging evidence that small intestinal dysbiosis can be a driver for the progression of chronic liver disease. Initially believed that small intestinal dysbiosis (e.g. SIBO) is mainly due to alterations of luminal conditions (e.g. after surgical resections of the ileocecal valve), there is now enough evidence to conclude that small intestinal dysbiosis can occur without underlying structural abnormalities.

Summary

Alterations of the SI-MAM appear to play a key role for the manifestation and progression of inflammatory and metabolic disorders.

Resta SC. Effects of probiotics and commensals on intestinal epithelial physiology: implications for nutrient handling. J Physiol. 2009;587:4169–74.PubMedPubMedCentral

Wu HJ, Wu E. The role of gut microbiota in immune homeostasis and autoimmunity. Gut Microbes. 2012;3:4–14.PubMedPubMedCentral

Camilleri M, Madsen K, Spiller R, van Meerveld BG, Verne GN. Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterol Motil. 2012;24:503–12.PubMedPubMedCentral

Bik EM, Eckburg PB, Gill SR, Nelson KE, Purdom EA, Francois F, et al. Molecular analysis of the bacterial microbiota in the human stomach. Proc Natl Acad Sci U S A. 2006;103:732–7.PubMedPubMedCentral

Guarner F, Malagelada JR. Gut flora in health and disease. Lancet. 2003;361:512–9.PubMed

Petersen C, Round JL. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol. 2014;16:1024–33.PubMedPubMedCentral

Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016;375:2369–79.PubMed

Carding S, Verbeke K, Vipond DT, Corfe BM, Owen LJ. Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis. 2015;26.

Sheridan WG, Lowndes RH, Young HL. Intraoperative tissue oximetry in the human gastrointestinal tract. Am J Surg. 1990;159:314–9.PubMed

10.

Corazza GR, Menozzi MG, Strocchi A, Rasciti L, Vaira D, Lecchini R, et al. The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology. 1990;98:302–9.PubMed

11.

Plaut AG, Gorbach SL, Nahas L, Weinstein L, Spanknebel G, Levitan R. Studies of intestinal microflora. 3. The microbial flora of human small intestinal mucosa and fluids. Gastroenterology. 1967;53:868–73.PubMed

12.

Bardhan PK, Gyr K, Beglinger C, Vögtlin J, Frey R, Vischer W. Diagnosis of bacterial overgrowth after culturing proximal small-bowel aspirate obtained during routine upper gastrointestinal endoscopy. Scand J Gastroenterol. 1992;27:253–6.PubMed

13.

Leon-Barua R, Gilman RH, Rodriguez C, et al. Comparison of three methods to obtain upper small bowel contents for culture. Am J Gastroenterol. 1993;88:925–8.PubMed

14.

Hamilton I, Worsley BW, Cobden I, Cooke EM, Shoesmith JG, Axon AT. Simultaneous culture of saliva and jejunal aspirate in the investigation of small bowel bacterial overgrowth. Gut. 1982;23:847–53.PubMedPubMedCentral

15.

Husebye E, Skar V, Hoverstad T, Melby K. Fasting hypochlorhydria with gram positive gastric flora is highly prevalent in healthy old people. Gut. 1992;33:1331–7.PubMedPubMedCentral

16.

Holt PR, Rosenberg IH, Russell RM. Causes and consequences of hypochlorhydria in the elderly. Dig Dis Sci. 1989;34:933–7.PubMed

17.

Lipski PS, Kelly PJ, James OF. Bacterial contamination of the small bowel in elderly people: is it necessarily pathological? Age Ageing. 1992;21:5–12.PubMed

18.

MacMahon M, Lynch M, Mullins E, et al. Small intestinal bacterial overgrowth--an incidental finding? J Am Geriatr Soc. 1994;42:146–9.PubMed

19.

Saltzman JR, Kowdley KV, Pedrosa MC, Sepe T, Golner B, Perrone G, et al. Bacterial overgrowth without clinical malabsorption in elderly hypochlorhydric subjects. Gastroenterology. 1994;106:615–23.PubMed

20.

Riordan SM, McIver CJ, Duncombe VM, et al. Bacteriologic analysis of mucosal biopsy specimens for detecting small-intestinal bacterial overgrowth. Scand J Gastroenterol. 1995;30:681–5.PubMed

21.

Khoshini R, Dai SC, Lezcano S, Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008;53:1443–54.PubMed

22.

King CE, Toskes PP. Small intestine bacterial overgrowth. Gastroenterology. 1979;76:1035–55.PubMed

23.

Hamilton JD, Dyer NH, Dawson AM, O'Grady FW, Vince A, Fenton JC, et al. Assessment and significance of bacterial overgrowth in the small bowel. Q J Med. 1970;39:265–85.PubMed

24.

Erdogan A, Rao SS. Small intestinal fungal overgrowth. Curr Gastroenterol Rep. 2015;17:16.PubMed

25.

Jacobs C, Coss Adame E, Attaluri A, Valestin J, Rao SSC. Dysmotility and ppi use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Aliment Pharmacol Ther. 2013;37:1103–11.PubMedPubMedCentral

26.

• Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, et al. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Dig Dis Sci. 2012;57:1321–9 Utilsing culture methods, SIBO was found in 37.5% of IBS sufferers (60% of IBS patients with predominant diarrhea compared to 27.3% without diarrhea).PubMed

27.

Quigley EM. Small intestinal bacterial overgrowth: what it is and what it is not. Curr Opin Gastroenterol. 2014;30:141–6.PubMed

28.

Quigley EM, Abu-Shanab A. Small intestinal bacterial overgrowth. Infect Dis Clin N Am. 2010;24:943–59 viii-ix.

29.

Abu-Shanab A, Quigley EM. Diagnosis of small intestinal bacterial overgrowth: the challenges persist! Expert Rev Gastroenterol Hepatol. 2009;3:77–87.PubMed

30.

Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent M, et al. Diversity of the human intestinal microbial Flora. Science. 2005;308:1635–8.PubMedPubMedCentral

31.

Tabaqchali S. The pathophysiological role of small intestinal bacterial flora. Scand J Gastroenterol Suppl. 1970;6:139–63.PubMed

32.

Tillman R, King C, Toskes P. Continued Experience With The Xylose Breath Test-Evidence That The Small Bowel Culture As The Gold Standard For Bacterial Overgrowth May Be Tarnished, In Gastroenterology, Wb Saunders Co-Elsevier Inc 1600 John F Kennedy Boulevard, Ste 1800, Philadelphia, Pa 19103–2899 Usa, 1981.

33.

Zoetendal EG, Rajilic-Stojanovic M, de Vos WM. High-throughput diversity and functionality analysis of the gastrointestinal tract microbiota. Gut. 2008;57:1605–15.PubMed

34.

Gevers D, Kugathasan S, Denson LA, Vázquez-Baeza Y, van Treuren W, Ren B, et al. The treatment-naive microbiome in new-onset Crohn's disease. Cell Host Microbe. 2014;15:382–92.PubMedPubMedCentral

35.

Gorkiewicz G, Thallinger GG, Trajanoski S, Lackner S, Stocker G, Hinterleitner T, et al. Alterations in the colonic microbiota in response to osmotic diarrhea. PLoS One. 2013;8:e55817.PubMedPubMedCentral

36.

Fagan KJ, Rogers GB, Melino M, Arthur DM, Costello ME, Morrison M, et al. Ascites bacterial burden and immune cell profile are associated with poor clinical outcomes in the absence of overt infection. PLoS One. 2015;10:e0120642.PubMedPubMedCentral

37.

Sundin J, Rangel I, Fuentes S, Heikamp-de Jong I, Hultgren-Hörnquist E, de Vos WM, et al. Altered faecal and mucosal microbial composition in post-infectious irritable bowel syndrome patients correlates with mucosal lymphocyte phenotypes and psychological distress. Aliment Pharmacol Ther. 2015;41:342–51.PubMed

38.

Human Microbiome Project C. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486:207–14.

39.

Nistal E, Caminero A, Herran AR, et al. Differences of small intestinal bacteria populations in adults and children with/without celiac disease: effect of age, gluten diet, and disease. Inflamm Bowel Dis. 2012;18:649–56.PubMed

40.

Cheng J, Kalliomaki M, Heilig HG, et al. Duodenal microbiota composition and mucosal homeostasis in pediatric celiac disease. BMC Gastroenterol. 2013;13:113.PubMedPubMedCentral

41.

Wacklin P, Kaukinen K, Tuovinen E, Collin P, Lindfors K, Partanen J, et al. The duodenal microbiota composition of adult celiac disease patients is associated with the clinical manifestation of the disease. Inflamm Bowel Dis. 2013;19:934–41.PubMed

42.

Li G, Yang M, Zhou K, et al. Diversity of duodenal and rectal microbiota in biopsy tissues and luminal contents in healthy volunteers. J Microbiol Biotechnol. 2015.

43.

D'Argenio V, Casaburi G, Precone V, Pagliuca C, Colicchio R, Sarnataro D, et al. Metagenomics reveals Dysbiosis and a potentially Pathogenic N. flavescens strain in duodenum of adult celiac patients. Am J Gastroenterol. 2016;111:879–90.PubMedPubMedCentral

44.

Chen Y, Ji F, Guo J, Shi D, Fang D, Li L. Dysbiosis of small intestinal microbiota in liver cirrhosis and its association with etiology. Sci Rep. 2016;6:34055.PubMedPubMedCentral

45.

Nistal E, Caminero A, Herran AR, et al. Study of duodenal bacterial communities by 16S rRNA gene analysis in adults with active celiac disease vs non-celiac disease controls. J Appl Microbiol. 2016;120:1691–700.PubMed

46.

Pellegrini S, Sordi V, Bolla AM, Saita D, Ferrarese R, Canducci F, et al. Duodenal mucosa of patients with type 1 diabetes shows distinctive inflammatory profile and microbiota. J Clin Endocrinol Metab. 2017;102:1468–77.PubMed

47.

D'Argenio V, Casaburi G, Precone V, Pagliuca C, Colicchio R, Sarnataro D, et al. No change in the mucosal gut microbiome is associated with celiac disease-specific microbiome alteration in adult patients. Am J Gastroenterol. 2016;111:1659–61.PubMed

48.

Chandra S, Dutta U, Noor MT, Taneja N, Kochhar R, Sharma M, et al. Endoscopic jejunal biopsy culture: a simple and effective method to study jejunal microflora. Indian J Gastroenterol. 2010;29:226–30.PubMed

49.

•• Shanahan ER, Zhong L, Talley NJ, Morrison M, Holtmann G. Characterisation of the gastrointestinal mucosa-associated microbiota: a novel technique to prevent cross-contamination during endoscopic procedures. Aliment Pharmacol Ther. 2016;43:1186–96 A novel technique utilsing a sheeted biopsy forceps is used to assess the mucosa associated microbiome in the small intestine that overcomes problems of cross contamination when biospies taken during routine endoscopies.PubMed

50.

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. 2002;97:1113–26.PubMed

51.

Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology. 1988;95:982–8.PubMed

52.

Metz G, Gassull MA, Drasar BS, Jenkins DJ, Blendis LM. Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet. 1976;1:668–9.PubMed

53.

Rhodes JM, Middleton P, Jewell DP. The lactulose hydrogen breath test as a diagnostic test for small-bowel bacterial overgrowth. Scand J Gastroenterol. 1979;14:333–6.PubMed

54.

Gasbarrini A, Corazza GR, Gasbarrini G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome consensus conference. Aliment Pharmacol Ther. 2009;29(Suppl 1):1–49.PubMed

55.

Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the north American consensus. Am J Gastroenterol. 2017;112:775–84.PubMedPubMedCentral

56.

Bjorneklett A, Jenssen E. Relationships between hydrogen (H2) and methane (CH4) production in man. Scand J Gastroenterol. 1982;17:985–92.PubMed

57.

American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea. Gastroenterology. 1999;116:1461–3.

58.

Bouhnik Y, Alain S, Attar A, Flourie B, Raskine L, Sanson-le Pors MJ, et al. Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol. 1999;94:1327–31.PubMed

59.

Grace E, Shaw C, Whelan K, Andreyev HJN. Review article: small intestinal bacterial overgrowth--prevalence, clinical features, current and developing diagnostic tests, and treatment. Aliment Pharmacol Ther. 2013;38:674–88.PubMed

60.

Gutierrez IM, Kang KH, Calvert CE, Johnson VM, Zurakowski D, Kamin D, et al. Risk factors for small bowel bacterial overgrowth and diagnostic yield of duodenal aspirates in children with intestinal failure: a retrospective review. J Pediatr Surg. 2012;47:1150–4.PubMedPubMedCentral

61.

Dlugosz A, Winckler B, Lundin E, Zakikhany K, Sandström G, Ye W, et al. No difference in small bowel microbiota between patients with irritable bowel syndrome and healthy controls. Sci Rep. 2015;5:8508.PubMedPubMedCentral

62.

Tap J, Derrien M, Tornblom H, et al. Identification of an Intestinal Microbiota Signature Associated With Severity of Irritable Bowel Syndrome. Gastroenterology. 2017;152:111–123.e8.PubMed

63.

•• Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364:22–32 Landmark study that demonstrated that in patients with non-constipated IBS treatment with a non-absorbable antibiotic resulted in a proportion of patients in a prolonged improvement of symptoms.PubMed

64.

Zhong L, Shanahan ER, Raj A, Koloski NA, Fletcher L, Morrison M, et al. Dyspepsia and the microbiome: time to focus on the small intestine. Gut. 2017;66:1168–9.PubMed

65.

Du LJ, Chen BR, Kim JJ, et al. Helicobacter pylori eradication therapy for functional dyspepsia: systematic review and meta-analysis. World J Gastroenterol. 2016;22:3486–95.PubMedPubMedCentral

66.

Holtmann G, Goebell H, Holtmann M, Talley NJ. Dyspepsia in healthy blood donors. Pattern of symptoms and association with helicobacter pylori. Dig Dis Sci. 1994;39:1090–8.PubMed

67.

Andoh A, Kuzuoka H, Tsujikawa T, Nakamura S, Hirai F, Suzuki Y, et al. Multicenter analysis of fecal microbiota profiles in Japanese patients with Crohn's disease. J Gastroenterol. 2012;47:1298–307.PubMed

68.

De Cruz P, Kang S, Wagner J, et al. Association between specific mucosa-associated microbiota in Crohn's disease at the time of resection and subsequent disease recurrence: a pilot study. J Gastroenterol Hepatol. 2015;30:268–78.PubMed

69.

Walters B, Vanner SJ. Detection of bacterial overgrowth in IBS using the lactulose H2 breath test: comparison with 14C-D-xylose and healthy controls. Am J Gastroenterol. 2005;100:1566–70.PubMed

70.

Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol. 2008;103:958–63.PubMed

71.

Scarpellini E, Giorgio V, Gabrielli M, Lauritano EC, Pantanella A, Fundarò C, et al. Prevalence of small intestinal bacterial overgrowth in children with irritable bowel syndrome: a case-control study. J Pediatr. 2009;155:416–20.PubMed

72.

Park JS, Yu JH, Lim HC, Kim JH, Yoon YH, Park HJ, et al. Usefulness of lactulose breath test for the prediction of small intestinal bacterial overgrowth in irritable bowel syndrome. Korean J Gastroenterol. 2010;56:242–8.PubMed

73.

Zhao J, Zheng X, Chu H, Zhao J, Cong Y, Fried M, et al. A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients. Neurogastroenterol Motil. 2014;26:794–802.PubMed

74.

Rana SV, Sinha SK, Sikander A, Bhasin DK, Singh K. Study of small intestinal bacterial overgrowth in north Indian patients with irritable bowel syndrome: a case control study. Trop Gastroenterol. 2008;29:23–5.PubMed

75.

Parodi A, Greco A, Savarino E, et al. May breath test be useful in diagnosis of IBS patients? An Italian study, in gastroenterology, WB SAUNDERS CO-ELSEVIER INC 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103–2899 USA, 2007.

76.

Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010;8:504–8.PubMed

77.

Sachdeva S, Rawat AK, Reddy RS, Puri AS. Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: frequency and predictors. J Gastroenterol Hepatol. 2011;26(Suppl 3):135–8.PubMed

78.

Lupascu A, Gabrielli M, Lauritano EC, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157–60.PubMed

79.

Posserud I, Stotzer PO, Bjornsson ES, Abrahamsson H, Simren M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–8.PubMed

80.

Choung RS, Ruff KC, Malhotra A, Herrick L, Locke GR III, Harmsen WS, et al. Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture. Aliment Pharmacol Ther. 2011;33:1059–67.PubMed

81.

Giamarellos-Bourboulis EJ, Pyleris E, Barbatzas C, Pistiki A, Pimentel M. Small intestinal bacterial overgrowth is associated with irritable bowel syndrome and is independent of proton pump inhibitor usage. BMC Gastroenterol. 2016;16:67.PubMedPubMedCentral

82.

Ghoshal UC, Srivastava D, Ghoshal U, Misra A. Breath tests in the diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome in comparison with quantitative upper gut aspirate culture. Eur J Gastroenterol Hepatol. 2014;26:753–60.PubMed

83.

Shimura S, Ishimura N, Mikami H, Okimoto E, Uno G, Tamagawa Y, et al. Small intestinal bacterial overgrowth in patients with refractory functional gastrointestinal disorders. J Neurogastroenterol Motil. 2016;22:60–8.PubMedPubMedCentral

84.

Costa MB, Azeredo IL Jr, Marciano RD, et al. Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test. Arq Gastroenterol. 2012;49:279–83.PubMed

85.

Rana SV, Sharma S, Malik A, Kaur J, Prasad KK, Sinha SK, et al. Small intestinal bacterial overgrowth and orocecal transit time in patients of inflammatory bowel disease. Dig Dis Sci. 2013;58:2594–8.PubMed

86.

Mishkin D, Boston FM, Blank D, Yalovsky M, Mishkin S. The glucose breath test: a diagnostic test for small bowel stricture(s) in Crohn's disease. Dig Dis Sci. 2002;47:489–94.PubMed

87.

Lee JM, Lee KM, Chung YY, Lee YW, Kim DB, Sung HJ, et al. Clinical significance of the glucose breath test in patients with inflammatory bowel disease. J Gastroenterol Hepatol. 2015;30:990–4.PubMed

88.

•• Rana SV, Sharma S, Kaur J, Prasad KK, Sinha SK, Kochhar R, et al. Relationship of cytokines, oxidative stress and GI motility with bacterial overgrowth in ulcerative colitis patients. J Crohn's Colitis. 2014;8:859–65 UC patients with elevated inflammatory cytokines showed delayed gastrointestinal transit times and increased risk for SIBO.

89.

•• Sánchez-Montes C, Ortiz V, Bastida G, et al. Small intestinal bacterial overgrowth in inactive Crohn’s disease: influence of thiopurine and biological treatment. World J Gastroenterol. 2014;20:13999–4003 Treatment with imunosuppressants is not associated with an increased SIBO risk in patients with Crohn's disease.PubMedPubMedCentral

90.

Rutgeerts P, Ghoos Y, Vantrappen G, et al. Ileal dysfunction and bacterial overgrowth in patients with Crohn's disease. Eur J Clin Investig. 1981;11:199–206.

91.

Castiglione F, Del Vecchio BG, Rispo A, et al. Orocecal transit time and bacterial overgrowth in patients with Crohn's disease. J Clin Gastroenterol. 2000;31:63–6.PubMed

92.

Ricci JERJ, Chebli LA, Ribeiro T, et al. Small-intestinal bacterial overgrowth is associated with concurrent intestinal inflammation but not with systemic inflammation in Crohn's disease patients. J Clin Gastroenterol. 2018;52:530–6.

93.

Klaus J, Spaniol U, Adler G, Mason RA, Reinshagen M, von Tirpitz C C. Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's disease. BMC Gastroenterol. 2009;9:61.PubMedPubMedCentral

94.

Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009;43:157–61.PubMedPubMedCentral

95.

Mooney PD, Evans KE, Sanders DS. Letter: coeliac disease and small intestinal bacterial overgrowth--is dysmotility the missing link? Aliment Pharmacol Ther. 2014;39:902–3.PubMed

96.

Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003;98:839–43.PubMed

97.

Miele L, Valenza V, La Torre G, et al. Increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease. Hepatology. 2009;49:1877–87.PubMed

98.

George NS, Sankineni A, Parkman HP. Small intestinal bacterial overgrowth in gastroparesis. Dig Dis Sci. 2014;59:645–52.PubMed

99.

Reddymasu SC, McCallum RW. Small intestinal bacterial overgrowth in gastroparesis: are there any predictors? J Clin Gastroenterol. 2010;44:e8–13.PubMed

100.

Sung HJ, Paik CN, Chung WC, Lee KM, Yang JM, Choi MG. Small intestinal bacterial overgrowth diagnosed by glucose hydrogen breath test in post-cholecystectomy patients. J Neurogastroenterol Motil. 2015;21:545–51.PubMedPubMedCentral

101.

von Wulffen M, Clark PJ, Macdonald GA, Raj AS, Kendall BJ, Powell EE, et al. Liver-related mortality in countries of the developed world: an ecological study approach to explain the variability. Aliment Pharmacol Ther. 2016;44:68–77.

102.

•• Shah A, Shanahan E, Macdonald GA, Fletcher L, Ghasemi P, Morrison M, et al. Systematic review and meta-analysis: prevalence of small intestinal bacterial overgrowth in chronic liver disease. Semin Liver Dis. 2017;37:388–400 This systematic review and metaanalysis provides strong evidence that SIBO is strongly associated with the progression of chronic liver disease.PubMed

103.

Sokol H, Pigneur B, Watterlot L, Lakhdari O, Bermudez-Humaran LG, Gratadoux JJ, et al. Faecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Natl Acad Sci U S A. 2008;105:16731–6.PubMedPubMedCentral

Titel: Gastroduodenal “Dysbiosis”: a New Clinical Entity
verfasst von: Ayesha Shah
Mark Morrison
Gerald J Holtmann, MD, PhD, MBA
Publikationsdatum: 12.11.2018
Verlag: Springer US
Erschienen in: Current Treatment Options in Gastroenterology / Ausgabe 4/2018
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-018-0207-x

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