Abstracts

A Clinical and Microbiological Study on Spontaneous Bacterial Peritonitis in Patients of Cirrhosis of

Liver with Ascites Due to Portal Hypertension
BPN Kaushik*, AK Das**
*

Senior Resident, AIIMS, New Delhi

Associate Professor, Department of Medicine, Assam Medical College and Hospital, Dibrugarh

**

Introduction: SBP is one of the potentially lethal complications of cirrhotic ascites. The profile of SBP varies with different ethnic, geographic, social and etiological factors. Prognosis of SBP is good if it is detected early. Once the most common organism causing SBP and its
antibiotic sensitivity is known, cost effective management protocols can be devised.
Aims and Objectives: To study the prevalence of SBP in patients of cirrhosis of liver with ascites due to portal hypertension, to find out
the most common organism causing SBP and its antibiotic sensitivity.
Methods: One year prospective single label open study conducted in Assam Medical College Hospital from 1st August 2008 to 31st July
2009. A total of 81 cases were included in study of which 71% were males and 29% females of which most of the patients were of 4150
years of age. Nine cases (11.11%) were diagnosed to have spontaneous bacterial peritonitis. Five out of 9 cases of SBP were culture positive. Escherichia coli was isolated in 4 cases (80%) and Klebsiella pneumonia in 1 case (20%). The organisms were sensitive for cefotaxime
in 3 cases, ceftriaxone in 2 and ciprofloxacin in 2 out of 4 cases of E. coli and K. pneumonia was sensitive to ciprofloxacin.
Conclusion: In end stage liver disease due to cirrhosis of liver with ascites, any triggering factor like SBP is sufficient to tilt the balance and
herald the cascade of consequences leading to death. All the patients of cirrhosis of liver at the time of admission should undergo diagnostic paracentesis, with examination of polymorphonuclear cells in ascitic fluid especially with cirrhotics with sudden increase of ascites or
worsening of their general condition. SBP can be diagnosed easily and hence clinicians should have a high index of suspicion and low
threshold for diagnosis. This will significantly alter the short-term prognosis.
Conflict of Interest: None

Small Intestinal Bacterial Overgrowth and Delayed Oro-cecal Transit Time in Cirrhotic Patients with
Minimal and Early Hepatic Encephalopathy
MK Lunia, A Agrawal, S Sachdeva, BC Sharma
Department of Gastroenterology, GB Pant Hospital, New Delhi
Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder because of inability of liver to perform its normal detoxification
function. Small intestinal bacterial overgrowth (SIBO) is common in cirrhotic patients and associated with systemic endotoxemia.
Aims: To compare SIBO and oro-cecal transit time (OCTT) in cirrhotic patients without hepatic encephalopathy (HE), with minimal
hepatic encephalopathy (MHE); and with early HE.
Methods: Eighty-two patients with cirrhosis were screened. Forty-five patients who met inclusion criteria were divided in 3 groups (Group 1:
No HE [n = 17], Group 2 MHE [n = 20], Group 3 early HE [n = 8]). MHE was diagnosed when the PHES was 4. Early HE (grade 1 and 2)
was defined according to West-Haven criteria. All patients underwent psychometry, glucose hydrogen breath test for SIBO and lactulose
breath test for OCTT.
Results: There was no significant difference in baseline characteristics between three groups. There was significant difference in SIBO
between Group 1 (17.6%), vs. Group 2 (55%) (p = 0.008) and between Group 1(17.6) vs. Group 3 (50%) (p = 0.008) while no difference
between Group 2 (55%) vs. Group 3 (50%) (p = 0.655). Prevalence of SIBO was higher in patients with CTP classes B and C (63.2%) compared to those in CTP class A (18.9%); p = 0.001. Mean OCTT in group 1, 2 and 3 was 115.3 11.8 min, 136.5 16.3 min and 137 15.8
min, respectively (p < 0.001). OCTT was significantly prolonged in patients who had SIBO (142.3 13.2 min) than in those who did not
have SIBO (115.4 8.3 min); (p < 0.001).
Conclusion: Our study conclusively demonstrates high prevalence of SIBO and prolonged OCTT in patients with cirrhosis with MHE and
early HE.
Conflict of Interest: None

2011, INASL

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