Research Progress on Small Intestinal Bacterial Overgrowth in Liver Cirrhosis: From Diagnosis via Methane and Hydrogen Breath Tests to Clinical Management

Abstract

In this paper, the author has tried to present a systematic review of the current research developments on the topic of small intestinal bacterial overgrowth (SIBO) in liver cirrhosis, focusing on its pathophysiology, non - invasive diagnosis, and its impact on patient outcomes. It discusses the mechanisms by which the changes in the intestinal environment consequent to cirrhosis promote abnormal bacteria growth in the small intestine by a synthesis of recent basic and clinical evidence. In addition, it discusses the mechanisms where the increased intestinal permeability, inflammation, and bacterial translocation worsen the progression of diseases and complications. It also evaluates the applicability, limitations, and optimization plans of the hydrogen breath test of this category of patients. The existing evidence indicates that SIBO is strongly common among the patients with cirrhosis and is closely associated with the level of disease and its complications manifested as hepatic encephalopathy, infections, and nutritional disorders. Meanwhile, hydrogen breath test is one of the main screening tools that are suitable to be utilized on cirrhotic patients. To sum up, SIBO has an important role in the course of cirrhosis and emergence of related issues, and it has probable potential in the early identification of high - risk patients and treatment recommendations.