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Volume 72, Issue 2

Risk factors for small intestinal bacterial overgrowth in patients with acute ischaemic stroke Open Access

Abstract

The intestinal flora has become a promising new target in acute ischaemic stroke (AIS), and small intestinal bacterial overgrowth (SIBO) is a common pathological condition of the intestinal flora. Recently, the lactose hydrogen–methane breath test has emerged as a non-invasive and economical method for the detection of SIBO in AIS patients. Exploring the prevalence of SIBO and its associated risk factors will provide a clinical basis for the association between intestinal flora and AIS.

Given that the prevalence of SIBO and its risk factors in patients with AIS remain to be studied, there is a need to investigate them.

This study aimed to investigate the prevalence and risk factors of SIBO in patients with AIS

Eighty patients tested for SIBO using the lactulose hydrogen–methane breath test were evaluated. Patients were divided into SIBO-positive and SIBO-negative groups according to the presence or absence of SIBO, respectively. The baseline characteristics and clinical biochemical indicators of the patients were compared between the two groups. The independent risk factors and predictive value of SIBO in AIS patients were determined using multivariate logistic regression and receiver operating characteristic (ROC) curve analyses.

Of the 80 consecutive patients with AIS, 23 (28.8 %) tested positive for SIBO. Triglyceride (TG) and homocysteine (Hcy) levels were identified as independent risk factors for SIBO in patients with AIS using multivariate logistic regression analysis (<0.005). ROC curve analysis showed that the area under the curve (AUC) of TG was 0.690 (95 % CI 0.577–0.789, =0.002). The sensitivity, specificity and optimal cut-off values were 95.7 %, 35.1 % and 1.14 mmol l, respectively. The AUC of Hcy was 0.676 (95 % CI 0.562–0.776, =0.01). The sensitivity, specificity and optimal cut-off values were 73.9 %, 59.7 % and 14.1 µmol, respectively. When TG and Hcy levels were combined, the AUC increased to 0.764 (95 % CI 0.656–0.852, <0.001). The specificity and sensitivity were 61.4 and 82.6 %, respectively. This showed that the combined detection of TG and Hcy levels had a higher predictive value

The prevalence of SIBO in patients with AIS was 28.8 %. TG and Hcy levels are independent risk factors for SIBO in patients with AIS. Both markers had good predictive value for the occurrence of SIBO. In the future, we should actively utilize these indicators to prevent intestinal flora imbalance and the occurrence of SIBO.

  • Received:
  • Accepted:
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Keyword(s): acute ischaemic stroke , intestinal flora , prevalence , risk factors and small intestinal bacterial overgrowth
Funding
This study was supported by the:
  • National Natural Science Foundation of China (Award 81973157)
    • Principle Award Recipient: JingZhao
  • National Natural Science Foundation of China (Award 82173646)
    • Principle Award Recipient: JingZhao
© 2023 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2023-02-09
2024-04-26
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References

  1. Wang Y-J, Li Z-X, Gu H-Q, Zhai Y, Jiang Y et al. China Stroke Statistics: an update on the 2019 report from the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations. Stroke Vasc Neurol 2020; 5:211–239 [View Article]
     [Google Scholar]
  2. Ma Z, Deng G, Meng Z, Wu H. Hospitalization expenditures and out-of-pocket expenses in patients with stroke in Northeast China, 2015-2017: a pooled cross-sectional study. Front Pharmacol 2020; 11:596183 [View Article]
     [Google Scholar]
  3. Sender R, Fuchs S, Milo R. Revised estimates for the number of human and bacteria cells in the body. PLoS Biol 2016; 14:e1002533 [View Article]
     [Google Scholar]
  4. Ji M, Huang H, Lan X. Correlation between intestinal microflora in irritable bowel syndrome and severity. Dis Markers 2022; 2022:1031844 [View Article]
     [Google Scholar]
  5. Irrazábal T, Belcheva A, Girardin SE, Martin A, Philpott DJ. The multifaceted role of the intestinal microbiota in colon cancer. Mol Cell 2014; 54:309–320 [View Article] [PubMed]
     [Google Scholar]
  6. Buttó LF, Haller D. Dysbiosis in intestinal inflammation: cause or consequence. Int J Med Microbiol 2016; 306:302–309 [View Article]
     [Google Scholar]
  7. Luan H, Wang X, Cai Z. Mass spectrometry-based metabolomics: targeting the crosstalk between gut microbiota and brain in neurodegenerative disorders. Mass Spectrom Rev 2019; 38:22–33 [View Article]
     [Google Scholar]
  8. Stilling RM, van de Wouw M, Clarke G, Stanton C, Dinan TG et al. The neuropharmacology of butyrate: the bread and butter of the microbiota-gut-brain axis?. Neurochem Int 2016; 99:110–132 [View Article]
     [Google Scholar]
  9. Foster JA. Modulating brain function with microbiota. Science 2022; 376:936–937 [View Article] [PubMed]
     [Google Scholar]
  10. Yuan B, Lu XJ, Wu Q. Gut microbiota and acute central nervous system injury: a new target for therapeutic intervention. Front Immunol 2021; 12:800796 [View Article]
     [Google Scholar]
  11. Durgan DJ, Lee J, McCullough LD, Bryan RM. Examining the role of the microbiota-gut-brain axis in stroke. Stroke 2019; 50:2270–2277 [View Article]
     [Google Scholar]
  12. Singh V, Roth S, Llovera G, Sadler R, Garzetti D et al. Microbiota dysbiosis controls the neuroinflammatory response after stroke. J Neurosci 2016; 36:7428–7440 [View Article]
     [Google Scholar]
  13. Castaño-Rodríguez N, Mitchell HM, Kaakoush NO. NAFLD, Helicobacter species and the intestinal microbiome. Best Pract Res Clin Gastroenterol 2017; 31:657–668 [View Article] [PubMed]
     [Google Scholar]
  14. Sachdev AH, Pimentel M. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Ther Adv Chronic Dis 2013; 4:223–231 [View Article] [PubMed]
     [Google Scholar]
  15. Fialho A, Fialho A, Kochhar G, Schenone AL, Thota P et al. Association between small intestinal bacterial overgrowth by glucose breath test and coronary artery disease. Dig Dis Sci 2018; 63:412–421 [View Article]
     [Google Scholar]
  16. Ponziani FR, Pompili M, Di Stasio E, Zocco MA, Gasbarrini A et al. Subclinical atherosclerosis is linked to small intestinal bacterial overgrowth via vitamin K2-dependent mechanisms. World J Gastroenterol 2017; 23:1241–1249 [View Article] [PubMed]
     [Google Scholar]
  17. Rana S, Bhansali A, Bhadada S, Sharma S, Kaur J et al. Orocecal transit time and small intestinal bacterial overgrowth in type 2 diabetes patients from North India. Diabetes Technol Ther 2011; 13:1115–1120 [View Article] [PubMed]
     [Google Scholar]
  18. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M 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 [View Article]
     [Google Scholar]
  19. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol 2017; 112:775–784 [View Article]
     [Google Scholar]
  20. Lewis SJ, Potts LF, Malhotra R, Mountford R. Small bowel bacterial overgrowth in subjects living in residential care homes. Age Ageing 1999; 28:181–185 [View Article] [PubMed]
     [Google Scholar]
  21. Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol 2007; 3(2):112–122
     [Google Scholar]
  22. Parlesak A, Klein B, Schecher K, Bode JC, Bode C. Prevalence of small bowel bacterial overgrowth and its association with nutrition intake in nonhospitalized older adults. J Am Geriatr Soc 2003; 51:768–773 [View Article] [PubMed]
     [Google Scholar]
  23. Wei M, Huang Q, Liu Z, Luo Y, Xia J. Intestinal barrier dysfunction participates in the pathophysiology of ischemic stroke. CNS Neurol Disord Drug Targets 2021; 20:401–416 [View Article]
     [Google Scholar]
  24. Ye D, Hu Y, Zhu N, Gu W, Long G et al. Exploratory investigation of intestinal structure and function after stroke in mice. Mediators Inflamm 2021; 2021:1315797 [View Article]
     [Google Scholar]
  25. Huang Q, Xia J. Influence of the gut microbiome on inflammatory and immune response after stroke. Neurol Sci 2021; 42:4937–4951 [View Article] [PubMed]
     [Google Scholar]
  26. Oyama N, Winek K, Bäcker-Koduah P, Zhang T, Dames C et al. Exploratory investigation of intestinal function and bacterial translocation after focal Cerebral Ischemia in the mouse. Front Neurol 2018; 9:937 [View Article]
     [Google Scholar]
  27. Li J, Zhang R, Ma J, Tang S, Li Y et al. Mucosa-associated microbial profile is altered in small intestinal bacterial overgrowth. Front Microbiol 2021; 12:710940 [View Article]
     [Google Scholar]
  28. Song Y, Liu Y, Qi B, Cui X, Dong X et al. Association of small intestinal bacterial overgrowth with heart failure and its prediction for short-term outcomes. J Am Heart Assoc 2021; 10:e015292 [View Article]
     [Google Scholar]
  29. Gottlieb K, Le C, Wacher V, Sliman J, Cruz C et al. Selection of a cut-off for high- and low-methane producers using a spot-methane breath test: results from a large north American dataset of hydrogen, methane and carbon dioxide measurements in breath. Gastroenterol Rep 2017; 5:193–199 [View Article]
     [Google Scholar]
  30. Ghoshal UC. How to interpret hydrogen breath tests. J Neurogastroenterol Motil 2011; 17:312–317 [View Article] [PubMed]
     [Google Scholar]
  31. Kong C, Gao R, Yan X, Huang L, Qin H. Probiotics improve gut microbiota dysbiosis in obese mice fed a high-fat or high-sucrose diet. Nutrition 2019; 60:175–184 [View Article] [PubMed]
     [Google Scholar]
  32. Wei F, Liu Y, Bi C, Chen S, Wang Y et al. Nostoc sphaeroids Kütz ameliorates hyperlipidemia and maintains the intestinal barrier and gut microbiota composition of high-fat diet mice. Food Sci Nutr 2020; 8:2348–2359 [View Article] [PubMed]
     [Google Scholar]
  33. Wang M, Zhang S, Zhong R, Wan F, Chen L et al. Olive fruit extracts supplement improve antioxidant capacity via altering colonic microbiota composition in mice. Front Nutr 2021; 8:645099 [View Article]
     [Google Scholar]
  34. Jia X, Xu W, Zhang L, Li X, Wang R et al. Impact of Gut microbiota and microbiota-related metabolites on hyperlipidemia. Front Cell Infect Microbiol 2021; 11:634780 [View Article]
     [Google Scholar]
  35. Chernyavskiy I, Veeranki S, Sen U, Tyagi SC. Atherogenesis: hyperhomocysteinemia interactions with LDL, macrophage function, paraoxonase 1, and exercise. Ann N Y Acad Sci 2016; 1363:138–154 [View Article] [PubMed]
     [Google Scholar]
  36. Danese S, Sgambato A, Papa A, Scaldaferri F, Pola R et al. Homocysteine triggers mucosal microvascular activation in inflammatory bowel disease. Am J Gastroenterol 2005; 100:886–895 [View Article] [PubMed]
     [Google Scholar]
  37. Bressenot A, Pooya S, Bossenmeyer-Pourie C, Gauchotte G, Germain A et al. Methyl donor deficiency affects small-intestinal differentiation and barrier function in rats. Br J Nutr 2013; 109:667–677 [View Article] [PubMed]
     [Google Scholar]
  38. Boran P, Baris HE, Kepenekli E, Erzik C, Soysal A et al. The impact of vitamin B12 deficiency on infant gut microbiota. Eur J Pediatr 2020; 179:385–393 [View Article] [PubMed]
     [Google Scholar]
  39. Lurz E, Horne RG, Määttänen P, Wu RY, Botts SR et al. Vitamin B12 deficiency alters the Gut microbiota in a murine model of colitis. Front Nutr 2020; 7:83 [View Article]
     [Google Scholar]
  40. Brandsma E, Kloosterhuis NJ, Koster M, Dekker DC, Gijbels MJJ et al. A proinflammatory Gut microbiota increases systemic inflammation and accelerates atherosclerosis. Circ Res 2019; 124:94–100 [View Article]
     [Google Scholar]
  41. Spychala MS, Venna VR, Jandzinski M, Doran SJ, Durgan DJ et al. Age-related changes in the gut microbiota influence systemic inflammation and stroke outcome. Ann Neurol 2018; 84:23–36 [View Article] [PubMed]
     [Google Scholar]
  42. Wen SW, Shim R, Ho L, Wanrooy BJ, Srikhanta YN et al. Advanced age promotes colonic dysfunction and gut-derived lung infection after stroke. Aging Cell 2019; 18:e12980 [View Article]
     [Google Scholar]
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Risk factors for small intestinal bacterial overgrowth in patients with acute ischaemic stroke
J. Med. Microbiol. 72, 001666 (2023); https://doi.org/10.1099/jmm.0.001666
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