Bacterial Translocation and Endotoxemia in Obstructive Jaundice: The Protective Effect of Lactulose

Abstract

This is an experimental study in rats, examining bacterial translocation and endotoxemia in obstructive jaundice, as well as the protective effect of lactulose, an endotoxin-binding agent. Four groups were used: I = control, II = sham, III = common bile duct ligation and IV = common bile duct ligation + lactulose. Aerobic cultures of mesenteric lymph nodes and liver were performed, and endotoxin was measured in the portal vein and aorta. The aerobic bacterial concentration in the cecum was determined and the terminal ileum was examined histologically. The study showed that there was increased bacterial translocation as well as systemic and portal endotoxemia in all jaundiced animals. Lactulose treatment does not influence the occurrence of bacterial translocation, but it significantly reduced endotoxemia. All jaundiced animals presented an insignificant increase in their aerobic cecal flora, independently of lactulose treatment. Histology showed significant changes in intestinal morphology, which may contribute to disruption of the intestinal mucosal barrier. Our results indicate that lactulose treatment (a) had no effect on bacterial translocation in jaundiced rats and (b) it may decrease endotoxemia, probably due to intraluminal binding of endotoxin. These findings may be of clinical significance for surgery in the presence of obstructive jaundice.