The role of small intestinal bacterial overgrowth in the pathogenesis of hyperlipidemia.

OBJECTIVE: Introduction: Small intestinal bacterial overgrowth may cause the hyperlipidemia appearance by enterohepatic circulation disturbance which evolves on the background of the early bile acids deconjugation with further endotoxin production and oxidative stress in the liver with hyperproduction of cholesterol and atherogenic lipoproteins. The aim: the determination of prevalence and features of SIBO in a series of patients with hyperlipidemia and in control subjects. PATIENTS AND METHODS: Materials and methods: Nineteen patients with hyperlipidemia and ten control subjects were studied. Small intestinal bacterial overgrowth was assessed by a lactulose breath test. Such biochemical markers as CRP, ALT, AST, GGTP, apolipoprotein B, bilirubin, cholesterol and lipid profile were determined. Except the routine interpretation of lactulose breath test, which contains the SIBO detection, small intestinal transit time and hydrogen level evaluation with next comparison between groups of patients was realized. RESULTS: Results: Small intestinal bacterial overgrowth was present in 78.9% of patients with hyperlipidemia and 40% in control subjects. The maximal dose of H2 was particularly higher in patients with hyperlipidemia in comparison with control group (94,7±13,69 vs. 36,13±5,4). There was a strong correlation between AST level and SIBO existence in both groups (r=1). Positive connection between LDL, TG, VLDL and the dose of exhaled hydrogen on 120 minute (r=0.6, r= 0.62, r=0.7 respectively) and strong negative correlation between HDL and 120 minute dose (r=-0.74) in main group was marked. CONCLUSION: Conclusions: Patients with hyperlipidemia have a higher prevalence of small intestinal bacterial overgrowth and there is a relationship between H2 rate and LDL, TG, VLDL.

Changes of the Heart Valves in the Long Term After Chemoradiotherapy According to Different Protocols for Hodgkin's Lymphoma in Children and Adolescents.

Purpose: The purpose of our work was to study late cardiac complications after treatment for Hodgkin's lymphoma (HL) in children and adolescents. Methods: Sixty-seven patients were examined in the long term (>5 years) after chemoradiotherapy for HL according to two different programs of treatment (groups I and II). Mean total doses of radiotherapy (RT) to the mediastinum were 37.2 and 28.9 Gy, respectively. The status of the heart was assessed at the mean age of 22.7 years with electrocardiography (ECG) and echocardiography (EchoCG). Mean terms of follow-up were 16.4 and 9.5 years for group I and group II, respectively. Results: Incidence of ECG changes was equal between the groups (88% and 90%). The prevalence of signs of valvular calcifications and fibrosis was 70.9% after mediastinal doses ≥30 Gy, and 16.6% after lower doses (p = 0.002). Those changes led to considerable valvular dysfunction in four patients. EchoCG signs of pulmonary hypertension were seen in 33.3% patients of group I versus 4.8% in group II (p = 0.047). Pericardial effusion was observed in 7.4% and 5.1%, respectively (p = 1.0). Left ventricular ejection fraction decreased slightly only in two patients (one in each group). Conclusions: The RT mediastinal dose level is the important risk factor of late heart complications. Nevertheless, the differences in the rate and severity of those complications between the groups should be viewed with caution because of differences in the age at baseline and in follow-up terms. The survivors of HL should undergo life-long regular examinations of the heart status.