Small Intestinal Bacterial Overgrowth Diagnosed by a Breath Test and Improved by Rifaximin in a Patient with Hepatic Encephalopathy and Alcoholic Liver Cirrhosis

Akira Sakamaki; Kunihiko Yokoyama; Fusako Yamazaki; Hiroteru Kamimura; Kenya Kamimura; Masaaki Takamura; Junji Yokoyama; Shuji Terai

doi:10.2169/internalmedicine.4593-20

CASE REPORTS

Small Intestinal Bacterial Overgrowth Diagnosed by a Breath Test and Improved by Rifaximin in a Patient with Hepatic Encephalopathy and Alcoholic Liver Cirrhosis

Akira Sakamaki, Kunihiko Yokoyama, Fusako Yamazaki, Hiroteru Kamimura, Kenya Kamimura, Masaaki Takamura, Junji Yokoyama, Shuji Terai

Author information

Akira Sakamaki
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Kunihiko Yokoyama
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Fusako Yamazaki
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Hiroteru Kamimura
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Kenya Kamimura
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Masaaki Takamura
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Junji Yokoyama
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
Shuji Terai
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan

Keywords: hepatic encephalopathy, liver cirrhosis, poorly absorbed antibiotics, small intestinal bacterial overgrowth

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 15 Pages 1849-1853

DOI https://doi.org/10.2169/internalmedicine.4593-20

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Abstract

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.

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