Enteral glutamine reduces intestinal permeability in obstructive jaundice

Abstract

Introduction. Obstructive jaundice is associated with impaired intestinal barrier function and translocation of enteric bacteria and their products to the systemic circulation. Failure of intestinal barrier function may be associated with altered enterocyte metabolism and consequent changes in cell regeneration and repair. Glutamine is the main metabolic substrate for enterocytes and the provision of additional glutamine may be effective in improving gut barrier function. Methods. Baseline paracellular intestinal permeability (IP) was measured in 24 adult male Wistar rats using 14C_ polyethylene glycol ('4C-PEG). Animals were then randomised to receive either 3.5% glutamine solution or water daily by gavage. Standard rat chow and water were also administered under pair-fed conditions and IP was assessed again after 7 days. All animals then underwent bile duct ligation (BDL). Gavage and pair-feeding was continued for a further 7 days, before IP was measured once more. Jaundice was confirmed by measurement of serum bilirubin. Mucosal structure in both groups was assessed by morphometric analysis of sections of terminal ileum. Results. Intestinal permeability was similar in the two groups at baseline and after 7 days feeding. Following bile duct ligation, intestinal permeability was significantly lower in those animals receiving glutamine compared to those receiving water (p=0.015, Mann-Whitney U test). There was no significant difference in mucosal morphometry or mean serum bilirubin between treatment and control groups. Conclusion. These data suggest that enteral administration of glutamine reduces intestinal permeability in obstructive jaundice. Abbreviations: IP : intestinal permeability; PEG : polyethylene glycol; BDL : bile duct ligation