The importance of the bacterial overgrowth syndrome in the development of disorders metabolic functions of the liver in non-alcoholic fatty liver disease

• Main Authors: Ya. M. Vakhrushev, A. P. Lukashevich
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2021-02-01
• Series: Терапевтический архив
• Subjects: non-alcoholic fatty liver disease; bacterial overgrowth syndrome; metabolic disorders
• Online Access: https://ter-arkhiv.ru/0040-3660/article/viewFile/64710/47586
• ISSN: 0040-3660; 2309-5342

Aim. To study the basic metabolic functions of the liver in patients with non-alcoholic fatty liver disease and to assess the relationship of these disorders with the bacterial overgrowth syndrome. Materials and methods. 50 patients with non-alcoholic fatty liver disease at the stage of steatosis were examined. In the verification of the diagnosis, hepatobiliary system ultrasound and FibroMax test data were used. A study was conducted of indicators of lipid, carbohydrate, protein, pigment, mineral metabolism and the exchange of enzymes in the blood. The bacterial overgrowth syndrome was studied by the results of a hydrogen breath test with lactulose using a LactofаH2 analyzer. Results. Patients with non-alcoholic fatty liver disease showed a significant increase in total cholesterol (median 5.9 mmol/l vs 5.0 mmol/l, p=0.000013), triglycerides (1.35 g/l vs 0.9 g/l, p=0.014), glucose (5.65 mmol/l against 5.1 mmol/l, p=0.000001) of blood serum compared with the control group. An increase in total protein and a tendency to decrease in albumin, an increase in serum sodium and calcium were detected. In patients with non-alcoholic fatty liver disease there is a significant increase in the markers of cytolysis and cholestasis compared with the control group. The bacterial overgrowth syndrome was detected in 72% of cases, with ileocecal valve function impaired in 50% of patients, gastrointestinal motility slowed down, or colon dysbiosis occurred. A correlation analysis revealed positive relationships between the bacterial overgrowth syndrome on the one hand and glucose (r=0.83, p0.05), total protein (r=0.35, p0.05), calcium (r=0.5, p0.05) on the other hand; negative relationship between the bacterial overgrowth syndrome and albumin (r=-0.8, p0.05). In this case, a positive relationship between the bacterial overgrowth syndrome and the increase in glycemia after glucose loading, that is, absorption in the small intestine, was revealed. Conclusion. The established violations of the metabolic functions of the liver with non-alcoholic fatty liver disease are closely related to the bacterial overgrowth syndrome.