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A new theory of small intestinal bacteria overgrowth in nonalcoholic fatty liver disease?

World Journal of Gastroenterology

An article recently published in the January 14 issue of the World Journal of Gastroenterology has great significance for NASH. This article will undoubtedly bring about new pathogenesis and treatment of NASH.

Small intestinal bacterial overgrowth has been reported to play a role in the pathogenesis of NASH, endotoxin and TNF-¦Á being the possible mediators. Contrary to this hypothesis, in another study, antibiotic treatment did not normalize aminotransferase levels in NASH patients. This article describes an animal experiment of NASH by Dr. Wan-Chun Wu et al.

A research article to be published on January 14, 2008 in the World Journal of Gastroenterology addresses this question. Dr. Wan-Chun Wu et al established a NASH animal model by a high fat diet for 12 wks successfully, and treated with cidomycin after 8 wks of the high fat diet. A semi-solid colored marker was used for monitoring small intestinal transit. The proximal small intestine was harvested under sterile condition and processed for quantitation for aerobes (E. coli) and anaerobes (Lactobacilli). Liver pathologic score was calculated to qualify the severity of hepatitis. Serum ALT and AST levels were detected to evaluate the severity of hepatitis.

After 12 wks, they had significant findings. Small intestinal transit was inhibited in NASH group. Rats treated with cidomycin had higher small intestine transit rate than rats in NASH group. The high fat diet resulted in quantitative alterations in the aerobes (E. coli) but not in the anaerobics (Lactobacill). There was an increase in the number of E. coli in the proximal small intestinal flora in NASH group than in control group. TNF-¦Áconcentration was significantly higher in NASH group than in control group. TNF-¦Áconcentration was lower in cidomycin group than in NASH group. Treatment with cidomycin showed its effect by significantly lowering serum ALT, AST and TNF-¦Álevels of NASH rats. SIBO may decrease small intestinal movement in NASH rats. SIBO may be an important pathogenesis of Nash and treatment with cidomycin by mouth can alleviate the severity of NASH.

The results of this study suggest a promising future for many NASH patients. Due to the high disease incidence of NAFLD around the world and no effective treatment at present, this case reported by Dr. Wan-Chun Wu is surely worth the attention of both doctors and the public at large.


Reference: Wu WC, Zhao W, Li S. Small intestinal bacteria overgrowth decreases small intestinal motility in the NASH rats. World J Gastroenterol 2008 January; 14(2):313-317

Correspondence to: Wan-Chun Wu, Department of Gastroenterology, Yijishan Hospital, Wuhu 241000, Anhui Province, China.
Telephone: +86-553-5739106

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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