Small Intestinal Bacterial Overgrowth Diagnosed by a Breath Test and Improved by Rifaximin in a Patient with Hepatic Encephalopathy and Alcoholic Liver Cirrhosis
Small Intestinal Bacterial Overgrowth Diagnosed by a Breath Test and Improved by Rifaximin in a Patient with Hepatic Encephalopathy and Alcoholic Liver Cirrhosis
复制标题
DOI：
10.2169/internalmedicine.4593-20
复制
发表时间：
2020-01-01
影响因子：
1.2
通讯作者：
Terai, Shuji
中科院分区：
文献类型：
--
作者：
Sakamaki, Akira;Yokoyama, Kunihiko;Terai, Shuji
1例66岁日本男性，因肝性脑病(HE)在本院住院治疗。腹部计算机断层扫描和实验室检查显示失代偿性肝硬变。静脉注射支链氨基酸可立即改善HE，并启动乳果糖。然而，呼气试验显示小肠细菌过度生长(SIBO)；因此，利福昔明被额外启动。出院后，当没有发现SIBO或明显的HE证据时，再次进行呼气测试。此病例提示呼气试验是鉴定SIBO的有效方法，对于服用乳果糖的SIBO阳性的HE患者，应考虑给予吸收不良的抗生素。
A 66-year-old Japanese man was admitted to our hospital with grade 2 hepatic encephalopathy (HE). Abdominal computed tomography and laboratory examinations revealed decompensated liver cirrhosis. Intravenous administration of branched-chain amino acids immediately ameliorated the HE, and lactulose was initiated. However, a breath test revealed small intestinal bacterial overgrowth (SIBO); therefore, rifaximin was additionally initiated. The breath test was repeated after discharge, when no evidence of SIBO or overt HE was identified. This case suggested that a breath test is effective for the identification of SIBO and that the administration of a poorly absorbed antibiotic should be considered in SIBO-positive HE patients taking lactulose.