Research Article Open Access

Small Intestinal Bacterial Overgrowth in Gastric Cancer Patients in Relation to Helicobacter pylori Status and Gastric Cytokine Levels

Abstract

Objective: As Small intestinal bacterial overgrowth (SIBO) effects treatment decisions and quality of life of patients, information on the prevalence of SIBO in gastric cancer patients pertaining to predicting the development of SIBO from H. pylori status and effects of SIBO on gastric immunity is urgently needed. In this study, we attempt to estimate the prevalence of SIBO and examine the relationship between these factors in gastric cancer patients.

Methods: Eighty gastric cancer patients and thirty healthy controls were included in this prospective study. Preoperative glucose hydrogen breath tests were performed to diagnose SIBO and a urea breath test was performed to establish H. pylori status. Interleukine-6 (IL-6) and tumor necrosis factor-α (TNF-α) expression in tumor tissues was assessed by immunohistochemistry (IHC) in gastrectomy specimens. The correlation between SIBO and outcome measures was investigated.

Results: Gastric cancer is significantly associated with SIBO (45% vs. 6.67%, P<0.05), while hydrogen-breath-test-positivity was associated with Helicobacter-positivity (r=0.397, P<0.05). IL-6 and TNF-α expression were significantly higher in SIBO-positive patients than in SIBO-negative patients (P<0.05). Three-year cumulative survival rates for SIBO-positive patients were significantly lower than for SIBO-negative patients (P<0.05).

Conclusion: This study indicates that SIBO is common among gastric cancer patients, and is associated with poor outcome. H. pylori infection may play an important role in the development of SIBO. SIBO in poor performance patients with gastric cancer potentially relates to high gastric IL-6 and TNF-α levels in this patient group.

Xiaoying MA, Jing WANG, Zhenjun WU, Peng ZHANG, Lin XU and Zibin TIAN

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