Association of small intestinal bacterial overgrowth with portal hypertension in HCV-related cirrhosis: a cross-sectional study

Abstract Small intestinal bacterial overgrowth (SIBO) is a frequent and clinically significant complication in patients with liver cirrhosis. However, its association with portal hypertension (PH) in HCV-related cirrhosis remains underexplored. To determine the prevalence, predictors, and clinical associations of SIBO in patients with HCV-related cirrhosis, with particular emphasis on its relationship to portal hypertension. In this cross-sectional study, we evaluated 90 patients with HCV-related cirrhosis and 30 control subjects without liver disease. SIBO was diagnosed using quantitative duodenal aspirate cultures. Clinical, laboratory, and endoscopic data were collected. Multivariate logistic regression was performed to identify independent predictors of SIBO. SIBO was detected in 63% of cirrhotic patients with portal hypertension, 41.7% of those without portal hypertension, and 6.7% of controls ( p < 0.001). Detectable HCV RNA was significantly associated with higher SIBO prevalence and increased bacterial colony counts ( p < 0.001). The most frequently isolated organisms were Enterococcus faecalis and Streptococci. Multivariate analysis identified age (OR = 1.09, p = 0.002), FIB-4 (OR = 1.61, p = 0.001), MELD score (OR = 1.15, p = 0.005), and portal hypertension (OR = 2.89, p = 0.048) as independent predictors of SIBO. SIBO is highly prevalent in HCV-related cirrhosis, especially in patients with portal hypertension and ongoing HCV replication. Age, FIB-4, MELD, and portal hypertension are independent predictors of SIBO. Screening for and managing SIBO may be particularly important in patients with advanced liver disease, especially those with portal hypertension.