Abstract :Background and Aim: Bacterial ammonia is considered to play a significant role in the pathogenesis
of (minimal) hepatic encephalopathy ((M) HE). The urease activity of intestinal bacteria is
recognized as a relevant factor. This has led to therapeutic strategies based on non-resorbable
antibiotics and non-resorbable disacchararides. The role of small intestinal bacterial overgrowth
(SIBO) is still unclear whereby recently published studies revealed a significant association between
the prevalence of SIBO and MHE.
Patients and Methods: 52 consecutive patients with liver cirrhosis underwent MHE testing by
critical flicker frequency analysis and testing for SIBO with the H2
glucose breath test (H2
BT).
Results: The prevalence of MHE was 38.5% whereas the prevalence of SIBO was 0% in patients
suffering from MHE and 3.2% in cirrhotic patients without MHE.
Discussion and Conclusion: Non-invasive tests for SIBO do not detect dysbalances in the
microbiota of the gastrointestinal tract involved in the pathogenesis of MHE. Molecular techniquedriven
approaches are needed to identify distinct changes in the bacterial composition in patients
with (M) HE.