Significant Increase in Intestinal Permeability in Acute-On-Chronic Liver Failure (ACLF) is Reversed After Slow Albumin Furosemide Infusion With or Without Terlipressin

Abstract

Background and Aim: Increased intestinal permeability (IP), increased bacterial translocation (BT), small intestinal bacterial overgrowth (SIBO) and gut dysbiosis are well known in liver cirrhosis (LC). In acute-on-chronic liver failure (ACLF), marked increase in IP and BT may occur due to a surge in portal hypertension. The study was done to compare IP in healthy controls, in patients with decompensated liver cirrhosis and in patients with ACLF before and after control of large ascites with SAFI ± T therapy. Methods: Measuring lactulose/mannitol ratio (LMR) in the urine using 1H NMR spectroscopy is a simple, efficient way to assess intestinal permeability (IP). Urinary LMR was measured in 20 healthy controls, 20 patients with decompensated (CTP-B,C) LC, 20 patients of ACLF before therapy out of which 20 patients after ascites mobilisation of large ascites which was treated with continuous slow albumin and furosemide infusion with or without terlipressin were included in study. Among this last group average duration of therapy was 14 days. Results: IP was highest in ACLF patients before treatment with SAFI ± TMedian value urinary LMR 1.4, intermediate in decompensated cirrhotics 0.55 and lowest in healthy volunteers 0.11. After control of ascites with SAFI ± T in ACLF, urinary LMR was similar to normal controls 0.19 (P value in comparison to pre-treatment value was 0.03) suggesting that control of ascites in ACLF normalized the increased IP. Conclusion: ACLF patients have higher intestinal permeability compared with decompensated cirrhotics and controls. Intestinal permeability decreases after decongestive therapy, suggesting that intestinal decongestion may reverse increased IP in ACLF (Figure 1). The authors have none to declare.