{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:17:06Z","timestamp":1792109826004,"version":"4.4.0"},"reference-count":56,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Introduction: Non-alcoholic fatty liver disease (NAFLD) is a multifactorial, wide-spectrum liver disorder. Small intestinal bacterial overgrowth (SIBO) is characterized by an increase in the number and\/or type of colonic bacteria in the upper gastrointestinal tract. SIBO, through energy salvage and induction of inflammation, may be a pathophysiological factor for NAFLD development and progression. Aim\/Methods: Consecutive patients with histological, biochemical, or radiological diagnosis of any stage of NAFLD (non-alcoholic fatty liver [NAFL], non-alcoholic steatohepatitis [NASH], cirrhosis) underwent upper gastrointestinal endoscopy. Duodenal fluid (2cc) was aspirated from the 3rd\u20134th part of duodenum into sterile containers. SIBO was defined as \u2265103 aerobic colony-forming units (CFU)\/mL of duodenal aspirate and\/or the presence of colonic-type bacteria. Patients without any liver disease undergoing gastroscopy due to gastroesophageal reflux disease (GERD) comprised the healthy control (HC) group. Concentrations (pg\/mL) of tumor necrosis factor alpha (TNF\u03b1), interleukin (IL)-1\u03b2, and IL-6 were also measured in the duodenal fluid. The primary endpoint was to evaluate the prevalence of SIBO in NAFLD patients, while the comparison of SIBO prevalence among NAFLD patients and healthy controls was a secondary endpoint. Results: We enrolled 125 patients (51 NAFL, 27 NASH, 17 cirrhosis, and 30 HC) aged 54 \u00b1 11.9 years and with a weight of 88.3 \u00b1 19.6 kg (NAFLD vs. HC 90.7 \u00b1 19.1 vs. 80.8 \u00b1 19.6 kg, p = 0.02). Overall, SIBO was diagnosed in 23\/125 (18.4%) patients, with Gram-negative bacteria being the predominant species (19\/23; 82.6%). SIBO prevalence was higher in the NAFLD cohort compared to HC (22\/95; 23.2% vs. 1\/30; 3.3%, p = 0.014). Patients with NASH had higher SIBO prevalence (6\/27; 22.2%) compared to NAFL individuals (8\/51; 15.7%), but this difference did not reach statistical significance (p = 0.11). Patients with NASH-associated cirrhosis had a higher SIBO prevalence compared to patients with NAFL (8\/17; 47.1% vs. 8\/51; 15.7%, p = 0.02), while SIBO prevalence between patients with NASH-associated cirrhosis and NASH was not statistically different (8\/17; 47.1% vs. 6\/27; 22.2%, p = 0.11). Mean concentration of TNF-\u03b1, IL-1\u03b2, and IL-6 did not differ among the different groups. Conclusion: The prevalence of SIBO is significantly higher in a cohort of patients with NAFLD compared to healthy controls. Moreover, SIBO is more prevalent in patients with NASH-associated cirrhosis compared to patients with NAFL.<\/jats:p>","DOI":"10.3390\/microorganisms11030723","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T06:09:56Z","timestamp":1678687796000},"page":"723","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Prevalence of Small Intestinal Bacterial Overgrowth Syndrome in Patients with Non-Alcoholic Fatty Liver Disease\/Non-Alcoholic Steatohepatitis: A Cross-Sectional Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9677-4013","authenticated-orcid":false,"given":"Paraskevas","family":"Gkolfakis","sequence":"first","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2945-6007","authenticated-orcid":false,"given":"Georgios","family":"Tziatzios","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Leite","sequence":"additional","affiliation":[{"name":"Medically Associated Science and Technology (MAST) Program, Cedars-Sinai, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis S.","family":"Papanikolaou","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Xirouchakis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Athens Medical Palaio Faliron General Hospital, 17562 Palaio Faliron, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis G.","family":"Panayiotides","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, Medical School, National and Kapodistrian University of Athens, 124622 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Karageorgos","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jesus","family":"Millan","sequence":"additional","affiliation":[{"name":"Medically Associated Science and Technology (MAST) Program, Cedars-Sinai, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Mathur","sequence":"additional","affiliation":[{"name":"Medically Associated Science and Technology (MAST) Program, Cedars-Sinai, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Weitsman","sequence":"additional","affiliation":[{"name":"Medically Associated Science and Technology (MAST) Program, Cedars-Sinai, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0315-9936","authenticated-orcid":false,"given":"George D.","family":"Dimitriadis","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-3911","authenticated-orcid":false,"given":"Evangelos J.","family":"Giamarellos-Bourboulis","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Pimentel","sequence":"additional","affiliation":[{"name":"Medically Associated Science and Technology (MAST) Program, Cedars-Sinai, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-9426","authenticated-orcid":false,"given":"Konstantinos","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/hep.20920","article-title":"Insulin resistance: A metabolic pathway to chronic liver disease","volume":"42","author":"Bugianesi","year":"2005","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5169","DOI":"10.2174\/13816128113199990336","article-title":"Epidemiology and natural history of patients with NAFLD","volume":"19","author":"Bhala","year":"2013","journal-title":"Curr. 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