Intestinal Permeability In Patients Research Articles

Small-bowel permeability in collagenous colitis

Objective. Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies, indicating that CC is a pan-intestinal disease. In small-intestinal disease, the intestinal barrier function may be impaired, and the permeability of the small intestine altered. The purpose of this research was to study small-bowel function in patients with CC as expressed by intestinal permeability. Material andmethods. Ten patients with CC and chronic diarrhoea participated in the study. Coeliac disease was excluded by small-bowel biopsy and/or serology. Intestinal permeability was assessed as urinary excretion (ratios) 2, 4 and 6 h after ingestion of 14C-labelled mannitol (14C-mannitol) and 99mTc-labelled diethylenetriamine-pentaacetic acid (99mTc-DTPA). Data were compared with the results from healthy controls. Results. No difference was found between groups in urinary excretion of 14C-mannitol and 99mTc-DTPA after 2, 4 or 6 h, respectively. Likewise, no significant differences in the 99mTc-DTPA/14C-mannitol ratios between patients and controls were detected after 2 h: 0.030 (0.008–0.130) versus 0.020 (0.007–0.030), p=0.19, after 4 h: 0.040 (0.009–0.180) versus 0.020 (0.008–0.040), p=0.14 or after 6 h: 0.040 (0.012–0.180) versus 0.020 (0.010–0.040), p=0.17. Conclusions. No alterations in intestinal permeability in patients with CC could be demonstrated. Impairment of the integrity of the mucosa of the small bowel and the presence of a general dysfunction of the small intestine in patients with CC seem unlikely.

4. Probiotics, breastfeeding and atopic eczema

This article focuses on several aspects as follows; the relationship between permeability of the gastrointestinal tract and atopic eczema, probiotics and eczema, probiotics and the immune system in the gastrointestinal tract, breastfeeding and immunomodulation, and the relation between breastfeeding and the development of atopic eczema. It is concluded that there is evidence that some probiotic strains seem to be beneficial in the treatment of atopic eczema. GUT MUCOSAL BARRIER AND ATOPIC ECZEMA The gut mucosal barrier of patients with atopic eczema is impaired. In an in vitro study Majamaa & Isolauri (1) studied the absorption of horseradish peroxidase (HRP) through the gut mucosal barrier. Small intestinal biopsies were studied in Ussing chambers, measuring the absorption of both intact and degraded HRP. Compared with controls, absorption in patients with atopic eczema is increased. There are also several studies showing increased intestinal permeability in patients with bronchial asthma. Benard et al. (2) studied the urinary excretion of Cr EDTA, a recognized method of monitoring intestinal absorption, in asthmatics, in patients with chronic obstructive airways disease and in controls. There were significant differences between the asthmatics and the other two groups in respect of increased intestinal permeability. There was no significant difference in intestinal permeability between patients with allergic and non-allergic asthma, and the intestinal permeability was not correlated with the severity of asthma as measured by FEV1.

Alterations in the colonic flora and intestinal permeability and evidence of immune activation in chronic constipation

Background. Disturbances in bowel function in chronic constipation could result in changes in the colonic flora and lead to disordered immunity and to decreased resistance to pathogenic flora. Aim. To investigate systemic immunity, the faecal flora and intestinal permeability in patients with chronic constipation, under basal conditions and following therapy with the laxative Bisacodyl. Methods. Intestinal permeability, faecal flora analysis, T- and B-lymphocyte numbers, T-cell subpopulations, lymphocyte proliferation, phagocytosis, intracellular killing of Staphylococcus aureus by neutrophils, as well as circulating levels of immunoglobulins, immune complexes and antibacterial antibodies were assessed in 57 patients with functional constipation. In 12 patients with severely delayed transit, investigations were repeated following therapy with Bisacodyl. Results. Ovalbumin concentrations, in serum, were higher in constipated patients (28.2 ± 4.1 ng/ml versus 1.0 ± 0.4 ng/ml, p < 0.05). Elevated counts of CD3+, CD4+, CD25+ cells, increased spontaneous proliferation of lymphocytes, elevated titres of antibodies to Escherichia coli and S. aureus, diminished counts of CD72+ B cells, diminished lymphocyte proliferation under phytohemagglutinin (PHA) stimulation and a diminished phagocytic index for both neutrophils and monocytes were found in the constipated patients. Concentrations of Bifidobacterium and Lactobacillus were significantly lower in constipated patients; potentially pathogenic bacteria and/or fungi were increased. Therapy with Bisacodyl resulted in normalisation of the faecal flora, a reduction in ovalbumin concentration and return towards normal for certain immunologic parameters. Conclusion. Constipation is associated with striking changes in the faecal flora, intestinal permeability and the systemic immune response. Relief of constipation tends to normalise these findings suggesting that these changes are secondary to, rather than a cause of, constipation.

Intestinal permeability and bacterial growth of the small bowel in patients with primary sclerosing cholangitis

Objective. Animal studies show that small intestinal bacterial overgrowth and infusion of bacterial antigens into portal blood cause hepatic histological changes similar to those seen in primary sclerosing cholangitis in man. It has been suggested that a similar mechanism involving bacterial overgrowth with increased small-bowel permeability may play a pathogenic role in patients with primary sclerosing cholangitis.Material and methods. Twenty-two patients with primary sclerosing cholangitis (13 M, 9 F, median age 37 years, range 21–74 years), 19 of whom (83%) had quiescent inflammatory bowel disease, were included in the study along with 18 healthy volunteers (9 F, 9 M, median age 36 years, range 23–80 years). Small-bowel bacterial overgrowth was defined as the presence of colonic flora >105 colony-forming units (cfu)/ml from duodenal aspirations. Small-bowel intestinal permeability was assessed as the differential urinary excretion of lactulose/L-rhamnose.Results. Bacterial overgrowth was evident in one patient with primary sclerosing cholangitis (4.5%) (Enterobacter) and in none of the controls. Intestinal permeability in patients with primary sclerosing cholangitis (0.034 (0.026–0.041) (median, interquartile range (IQR)) did not differ significantly from that of the controls (0.033 (0.025–0.041).Conclusions. Small intestinal bacterial overgrowth and increased intestinal permeability does not seem to play an important pathogenic role in patients with primary sclerosing cholangitis.

Intestinal permeability in patients with irritable bowel syndrome after a waterborne outbreak of acute gastroenteritis in Walkerton, Ontario

Post-infectious irritable bowel syndrome is a common clinical phenomenon of uncertain aetiology. To test the association between intestinal permeability and irritable bowel syndrome symptoms 2 years after a large waterborne outbreak of bacterial gastroenteritis. Consecutive adults with Rome I irritable bowel syndrome and controls without irritable bowel syndrome attending a community clinic were enrolled. Intestinal permeability was measured as the ratio of fractional urinary excretions of lactulose and mannitol, and compared among cases vs. controls and predictors of abnormal intestinal permeability were assessed. A total of 218 subjects (132 irritable bowel syndrome cases and 86 non-irritable bowel syndrome controls) completed the study protocol. About 27 (12%) had been diagnosed with the irritable bowel syndrome before the outbreak and 115 (53%) had been ill during the outbreak. Lactulose-mannitol ratios were increased among cases vs. controls (Mann-Whitney mean rank 118.8 vs. 95.3, P = 0.007), and cases were more likely to have a ratio >0.020 (P = 0.007). Among cases, those with increased intestinal permeability were more likely to report increased stool frequency. Both irritable bowel syndrome symptoms and male gender, but not diarrhoeal illness during the outbreak, were significant predictors of abnormal permeability. Irritable bowel syndrome symptoms are associated with a subtle increase in intestinal permeability irrespective of prior gastroenteritis. This may improve understanding of the aetiology of both sporadic and post-infectious irritable bowel syndrome.

Clinical study on glutamine-dipetide-supplemented parenteral nutrition after portacaval shunt

目的 探讨门腔分流术后病人给予含丙氨酰-谷氨酰胺双肽(Ala-GLN)肠外营养(PN)的安全性;观察其营养支持的效果,及对肠道通透性的影响.方法 16例病人随机分为两组.对照组(n=7)接受不含GLN的PN;实验组(n=9)接受含Ala-GLN双肽的PN.两组自术后第1天起给予等氮、等热量的PN共7 d,于PN前后分别测定血清前白蛋白、氮平衡变化、血清GLN浓度、血氨、尿乳果糖/甘露醇排泄率比值(L/M ratio)、生化和临床指标的变化.结果对照组术后血清GLN水平比术前显著降低,术后实验组GLN水平(577±42)μmol/L显著(P=0.009)高于对照组术后水平(499±61) μmol/L;两组术前的L/M比率均明显高于国人正常水平,术后对照组L/M水平(0.095±0.034)显著(P=0.045)高于实验组(0.064±0.023);两组累积氮平衡无显著性差异,但实验组第5～7天期间氮平衡要明显优于对照组,实验组第5天氮平衡(-15.3±46.9)mg·kg-1·d-1显著(P=0.043)好于对照组(-92.7±90.5)mg·kg-1·d-1;对照组术后血清前白蛋白水平较术前显著下降,实验组术后血清前白蛋白水平(0.269±0.037) g/L显著(P=0.001)高于对照组(0.199±0.027) g/L;两组术后血氨水平相比无统计学意义;生化指标的检测也基本无统计学意义;16名病人均顺利接受了门腔分流术,术后恢复良好,无术后并发症发生.结论 Ala-GLN双肽在肝硬化门静脉高压症接受门腔分流术病人中适量的应用是安全的;与不含Ala-GLN双肽的PN 相比,Ala-GLN双肽的添加可维持体内GLN水平并有更好的营养支持效果;并可以改善肠黏膜通透性。

Bile acid malabsorption or disturbed intestinal permeability in patients treated with enzyme substitution for exocrine pancreatic insufficiency is not caused by bacterial overgrowth.

In some patients with severe exocrine pancreatic insufficiency, enzyme replacement therapy will not lead to clinical improvement or reduction of steatorrhea. Therefore, other mechanisms separately or in interplay with reduced enzyme secretion might be responsible for malabsorption in these patients. To evaluate the prevalence of bacterial overgrowth, bile acid absorption capacity, and intestinal permeability in a group of patients with well-characterized exocrine pancreatic insufficiency. Eleven men with severe exocrine pancreatic insufficiency, of whom 10 were receiving enzyme replacement therapy, were studied. The prevalence of bacterial overgrowth was evaluated by means of a hydrogen and methane breath test with glucose. Gamma camera scintigraphy after intake of 75Se-homocholic acid taurine (75Se-HCAT) was used to evaluate bile acid absorption capacity. Intestinal permeability was assessed from urine excretion of ingested 14C-mannitol and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA), and these data were compared with results for 10 age-matched healthy men. No patients had abnormal breath hydrogen or methane concentrations after glucose intake. Abdominal retention of 75Se-HCAT was reduced in three of the patients. The patients had lower urine excretion of 14C-mannitol than the control subjects, whereas no difference was revealed in urine excretion of 99mTc-DTPA. Bile acid absorption and small intestinal permeability might be affected in patients with exocrine pancreatic insufficiency who receive treatment with enzyme supplementation. The prevalence of bacterial overgrowth seems to be low among these patients and does not explain the findings.

Host immune responses and intestinal permeability in patients with jaundice.

Systemic endotoxaemia is implicated in the development of complications associated with obstructive jaundice. The aims of these studies were to assess the systemic immune response to intervention in patients with jaundice and to compare the effects of surgical and non-surgical biliary drainage on host immune function and gut barrier function. In the first study, 18 jaundiced and 12 control patients were studied to assess systemic immune responses before and after intervention. In the second study, immune responses and gut barrier function were assessed following surgical and non-operative biliary decompression in 45 patients with jaundice. Endotoxin antibody concentrations fell significantly in patients with jaundice immediately after surgical intervention, but not after non-operative biliary drainage. This decrease was associated with a significant increase in serum P(55) soluble tumour necrosis factor (sTNF) receptor concentration (5.3 versus 10.5 ng/ml; P < 0.001), urinary excretion of P(55) TNF receptors (21.4 versus 78.8 ng/ml; P = 0.002) and intestinal permeability (lactulose : mannitol ratio 0.032 versus 0.082; P = 0.048). Intestinal permeability was significantly increased in patients with jaundice compared with controls (0.033 versus 0.015; P = 0.002). These data suggest that obstructive jaundice is associated with impaired gut barrier function and activation of host immune function that is exacerbated by intervention. Surgery causes an exaggerated pathophysiological disturbance not seen with non-operative biliary drainage procedures.

Intestinal Permeability to Mannitol and Lactulose in Children with Type 1 Diabetes with the HLA-DQB1*02 Allele

Food antigens and enteroviruses are possible triggers of type 1 diabetes. Because permeability of the intestinal epithelium may facilitate contact of these antigens with the mucosal immune system, we set out to study intestinal permeability in patients with type 1 diabetes. Children with type 1 diabetes (n = 26, mean age 12 years, mean duration of disease 4 years) and 24 healthy age-matched control children were given mannitol and lactulose orally, and their intestinal permeability was measured as a percentage of this dose recovered in urine. Patients with type 1 diabetes did not differ in their permeability to lactulose, nor was their lactulose/mannitol ratio any different from that of controls. However, patients with type 1 diabetes who had the HLA-DQB1 H 02 allele and, therefore, a higher risk for celiac disease (CD) absorbed significantly more mannitol (mean+95% CI): 17.7% (15.2-20.2) than did those negative for this allele: 12.3% (8.2-16.4), p = 0.04. Their lactulose permeability was also higher: 0.30 (0.16-0.44) and 0.09% (0-0.18), respectively, p = 0.02. Although the differences in permeability reach statistical significance, there was still much overlap between the two groups in terms of actual laboratory values. The higher permeability of patients with the HLA-DQB1 H 02 allele suggests that these patients may be more prone to develop abnormal immune responses to food antigens.

Randomized controlled trial of clarithromycin and ethambutol in the treatment of Crohn’s disease

A mycobacterial infection may be the cause of Crohn's disease in some patients. Measurement of intestinal permeability may identify Crohn's disease patients with a high likelihood of relapse and may quantify the severity of intestinal injury. To assess the effect of 3 months of clarithromycin and ethambutol on the disease activity and intestinal permeability in patients with Crohn's disease at high risk of relapse. Patients with Crohn's disease, with a lactulose-mannitol permeability test above 0.03, were randomly assigned to receive either clarithromycin, 500 mg twice daily, and ethambutol, 15 mg/kg daily, or identically appearing placebo for 3 months in addition to their regular therapy. The Harvey-Bradshaw index and the lactulose-mannitol test were assessed in a blind fashion every 3 months for 12 months. Thirty-one patients were randomized to receive either drugs (n=15) or placebo (n=16). The groups were similar in age, sex, duration of disease, location of disease, past complications and disease severity. Specifically, there was no difference between the drug or placebo groups in the mean Harvey-Bradshaw index (4.8 vs. 4.4), number with active disease (33% vs. 44%) and mean lactulose-mannitol test (0.06 vs. 0.10). During the 12-month follow-up period, there were no consistent, statistically significant differences in the mean Harvey-Bradshaw index or lactulose-mannitol test between treatment and placebo groups. Individual patients showed either improvement or worsening of these indices, but these were not related to study medication. Specifically, no 'cures' were noted with anti-mycobacterial treatment. Three months of treatment with clarithromycin and ethambutol does not benefit Crohn's disease patients who are receiving standard medical therapy.

Simultaneous determination of pulmonary and intestinal permeability in patients with alcoholic liver cirrhosis.

The aim of this prospective study was to assess pulmonary and intestinal permeability (PP and IP, respectively) in patients with alcoholic liver cirrhosis (ALC). Thirty-five non-smoking patients with biopsy-proven ALC were included (mean grade B in Child's classification). None had a previous history of pulmonary disease and all had a normal chest radiograph and computed tomography scan. Lung function tests and bronchoalveolar lavage (BAL) were also performed. The PP was studied by measuring the lung to blood clearance of inhaled 99mTc-DTPA aerosol. Clearance half-time (T 1/2, in minutes) and residual activity (RA in %) were obtained from exponential fitting of the right pulmonary clearance curve. IP was concurrently evaluated by measuring the urinary recovery of ingested 51Cr-EDTA, according to Bjarnason's technique and expressed as a percentage of the total oral dose. Results were compared with those obtained in non-smoking healthy control subjects. PP was significantly (P<0.05) increased in patients with ALC (T 1/2 65.9 +/- 32.2 min, RA 87.1% +/- 6.7%) versus control subjects (T 1/2 85.2 +/- 20.8 min, RA 92.8% +/- 2.6%). IP was not significantly different between patients and controls (2.39% +/- 2.20% vs 1.74% +/- 0.81%). A significant correlation (P<0.05) was found between PP and total cell number in BAL and total lymphocyte number in BAL. In conclusion, in patients with ALC, PP is increased without any association with IP, the severity of cirrhosis according to Child's classification or the results of pulmonary function tests. These findings may reflect primary involvement of the alveolar epithelium. In patients with ALC, PP is correlated with total cell number and total lymphocyte number. Increased PP may be due to activated cytotoxic lymphocytes and/or abnormal macrophage activity.

Intestinal permeability in patients with chemotherapy-induced stomatitis.

Mucositis represents one of the most common side effects of chemotherapy, and may affect any part of the gastrointestinal tract, resulting in stomatitis, dysphagia, dyspepsia, or diarrhea. The aim of the present study was to evaluate intestinal permeability in patients with stomatitis during treatment with oral granulocyte-monocyte colony-stimulating factor (GM-CSF, Leucomax). Ten patients with chemotherapy-induced stomatitis and 21 control cancer patients were included in the study. Intestinal permeability in patients with stomatitis was evaluated before and after the treatment with oral GM-CSF (200 micrograms for 4 consecutive days) by measuring urinary lactulose, D-xylose, and mannitol after oral challenge in collected urine using capillary gas chromatography. Mean grade of stomatitis (3, range 2-3) improved during treatment by a mean of 1 grade (range 0-2, sign test P < 0.05) with an improvement observed in eight of ten patients. Lactulose excretion, lactulose/mannitol, and lactulose/xylose ratios were markedly elevated in the patients with mucositis compared with 21 control cancer patients (1.60 +/- 1.04%, 0.2446 +/- 0.2937, and 0.3877 +/- 0.6808 vs 0.35 +/- 0.20%, 0.0332 +/- 0.0148, and 0.0255 +/- 0.0086, respectively, Mann Whitney U-test, P < 0.001). After treatment, lactulose excretion, lactulose/mannitol, and lactulose/xylose ratio decreased significantly (1.60 +/- 1.04 vs 0.63 +/- 0.42%; 0.2446 +/- 0.2937 vs 0.1303 +/- 0.1149; and 0.3877 +/- 0.6808 vs 0.1126 +/- 0.1146, respectively, P < 0.05). Lactulose excretion after oral challenge, lactulose/mannitol, or lactulose/xylose ratio may be useful markers for intestinal involvement in chemotherapy-induced mucositis. Improvement of oral mucositis was associated with a significant decrease of intestinal permeability to lactulose. Testing of intestinal permeability by the present method may be useful to evaluate the effect of therapeutic interventions in patients with chemotherapy-induced mucositis.

Intestinal permeability in strongyloidiasis.

The objective of the present study was to assess intestinal permeability in patients with infection caused by Strongyloides stercoralis. Twenty-six patients (16 women and 10 men), mean age 45.9, with a diagnosis of strongyloidiasis were evaluated. For comparison, 25 healthy volunteers (18 women and 7 men), mean age 44.9, without digestive disorders or intestinal parasites served as normal controls. Intestinal permeability was measured on the basis of urinary radioactivity levels during the 24 h following oral administration of chromium-labeled ethylenediaminetetraacetic acid ((51)Cr-EDTA) expressed as percentage of the ingested dose. The urinary excretion of (51)Cr-EDTA was significantly reduced in patients with strongyloidiasis compared to controls (1.60 +/- 0.74 and 3.10 +/- 1.40, respectively, P = 0.0001). Intestinal permeability is diminished in strongyloidiasis. Abnormalities in mucus secretion and intestinal motility and loss of macromolecules could explain the impaired intestinal permeability.

Lactulose-L-rhamnose intestinal permeability test in patients with liver cirrhosis

A lactulose-L-rhamnose intestinal permeability test was conducted on 35 patients with liver cirrhosis and six normal controls. Gas chromatography was used to measure lactulose and L-rhamnose concentrations in blood and urine specimens. The excretion of each molecule was expressed as the percentage of the orally administrated dose and the lactulose-L-rhamnose ratio as the ratio of the percentage of each probe molecule excreted. The mean 8-h lactulose excretion ratios were 0.56 and 0.16% in patients with liver cirrhosis and the control subjects, respectively ( P<0.05), whereas the corresponding excretion ratios for L-rhamnose were 4.40 and 3.49%. The mean lactulose-L-rhamnose excretion ratios in patients with liver cirrhosis and the control subjects were 0.124 and 0.049, respectively ( P<0.05). The lactulose-L-rhamnose excretion ratio increased in patients with liver cirrhosis complicated by large intestinal vascular ectasia of the large intestine or rectal varices, which were used as parameters for evaluating the effects of portal hypertension on the lower digestive tract. These results suggest that an increase in lactulose intestinal permeability in patients with liver cirrhosis proves the effects of portal hypertension extending to the lower digestive tract.

Increased intestinal permeability in patients with cirrhosis is related to the severity of the liver disease

Increased intestinal permeability in patients with cirrhosis is related to the severity of the liver disease

Evaluation of jejunal ultrasctructure and intestinal permeability in patients with total gastrectomy for gastric cancer

Evaluation of jejunal ultrasctructure and intestinal permeability in patients with total gastrectomy for gastric cancer

Abnormal Intestinal Permeability Predicts Relapse in Inactive Crohn Disease

Background: Trials of maintenance therapy in quiescent Crohn disease are often underpowered and there is need for objective markers that predict relapse. Intestinal permeability (IP) has been identified as such a marker although it is unknown how this relates to proposed clinical and blood markers of relapse. We aimed to assess the predictive value of intestinal permeability together with clinical and blood markers in a group of patients with inactive Crohn disease. Methods: We assessed 50 patients with inactive Crohn disease. Inactive disease was defined as a Crohn disease activity index of less than 150. Intestinal permeability was measured by the urinary excretion of lactulose and rhamnose and data relating to postulated clinical and blood markers predictive of relapse were collected. Follow-up for one year assessed whether patients had relapsed or remained in remission. Results: Of the 18 patients with abnormal intestinal permeability, 10 remained in remission and 8 relapsed. Of the 32 with a normal result, 31 remained in remission and 1 relapsed. Patients with abnormal intestinal permeability are significantly more likely to relapse than those with a normal result (chi-square = 14.3; P = 0.0001; relative risk 18). Those that relapsed had shorter disease duration. Multiple regression analysis identifies IP to be an independent variable. Conclusions: Abnormal intestinal permeability in patients with inactive Crohn disease predicts relapse. This is superior to clinical and blood markers. It is likely that this is due to ongoing subclinical mucosal inflammation. This may be of use when designing clinical trials of maintenance therapy.

Intestinal permeability in liver cirrhosis: relationship with severe septic complications.

Patients with liver cirrhosis are at high risk of severe septic complications such as spontaneous bacterial peritonitis (SBP) and bacteraemia. The aims of this study were to assess intestinal permeability in patients with liver cirrhosis and to search for a relationship between an impaired intestinal permeability and the occurrence of severe septic complications. Intestinal permeability was assessed in a group of 80 cirrhotic patients (Child A, n = 13; Child B, n = 26; Child C, n = 41) and 28 healthy control subjects. A severe septic complication (bacteraemia and/or SBP) occurred in 16 patients, within 10 days before (n = 8 cases) or after (n = 8 cases) the test was performed. Lactulose (LAC) 10 g was given orally together with mannitol (MAN) 5 g, and urinary excretion rates were determined. Urinary mannitol excretion (MAN%) was lower while the LAC/MAN ratio was higher in patients than in control subjects (P < 0.001); these abnormalities were more marked in Child C patients (Child C patients vs control subjects: MAN%, 8.20 +/- 0.79 vs 14.59 +/- 0.58, P < 0.001; LAC/MAN, 0.066 +/- 0.026 vs 0.017 +/- 0.001, P < 0.02). When compared with non-infected patients, septic patients had a lower MAN% and an increased LAC/ MAN ratio (5.45 +/- 1.12 vs 9.83 +/- 0.87, P < 0.02; 0.130 +/- 0.063 vs 0.029 +/- 0.005, P < 0.02). Although the main mechanism involved in the decrease in MAN% is likely a reduction in area of the intestinal absorptive surface, these results argue in favour of an increased intestinal permeability in liver cirrhosis, especially in patients with severe infectious complications. The impairment of intestinal function barrier may contribute to severe septic complications in these patients.

Early increase in intestinal permeability in patients with severe acute pancreatitis: correlation with endotoxemia, organ failure, and mortality

Sepsis accounts for 80% of deaths from acute pancreatitis. This study aimed to investigate early changes in intestinal permeability in patients with acute pancreatitis, and to correlate these changes with subsequent disease severity and endotoxemia. The renal excretion of enterally administered polyethylene glycol (PEG) 3350 and PEG 400 was measured within 72 hours of onset of acute pancreatitis to determine intestinal permeability. Severity was assessed on the basis of APACHE II scores and C-reactive protein measurements. Serum endotoxin and antiendotoxin antibodies were measured on admission. Eight-five patients with acute pancreatitis (mild in 56, severe in 29) and 25 healthy control subjects were studied. Urinary excretion of PEG 3350 (median) was significantly greater in patients who had severe attacks (0.61%) compared to those with mild disease (0.09%) and health control subjects (0.12%) ( P <0.0001), as was the permeability index (PEG 3350/400 excretion) ( P <0.00001). The permeability index was significantly greater in patients who subsequently developed multiple organ system failure and/or died compared with other severe cases (0.16 vs. 0.04) ( P = 0.0005). The excretion of PEG 3350 correlated strongly with endotoxemia ( r = 0.8; P = 0.002). Early increased intestinal permeability may play an important role in the pathophysiology of severe acute pancreatitis. Therapies that aim to restore intestinal barrier function may improve outcome.

Intestinal permeability in liver cirrhosis.

To determine the changes in intestinal permeability in liver cirrhosis and to investigate whether intestinal permeability relates to the stage and aetiology of cirrhosis or existence of spontaneous bacterial peritonitis (SBP). A prospective study of intestinal permeability in patients with cirrhosis. Gastroenterology and Nuclear Medicine Departments of Ege University Hospital. Intestinal permeability was assessed in 44 consecutive patients with cirrhosis and 10 healthy volunteers by measuring 24 h urine excretion of (99m)technetium diethyl triamine penta-acetic acid (99mTc DTPA). Cases with an associated disease, impaired renal function, continuing alcohol consumption and drug intake which is known to have an effect on intestinal permeability were excluded. Comparisons of 24 h urine excretion of 99mTc DTPA were made between the groups of cirrhotics and controls, different grades of cirrhosis (according to Child-Pugh criteria), alcoholic and non-alcoholic cirrhotics and cirrhotic patients with and without SBP. Patients with cirrhosis excreted 99mTc DTPA significantly more than controls (11.56 +/- 8.96% in cirrhotics and 4.30 +/- 1.49% in controls, P < 0.0001). There was no relationship of 24 h urine excretion of the tracer with the grade and aetiology of cirrhosis (12.20 +/- 9.47%, 11.41 +/- 9.84%, and 11.09 +/- 8.42%, in Child A, B, and C groups and 8.45 +/- 6.57% and 12.05 +/- 9.25% in alcoholic and non-alcoholic cirrhotics, respectively). No significant difference was found between cirrhotic patients with and without SBP in terms of excretion of the administered dose of 99mTc DTPA (9.98 +/- 9.47% and 12.20 +/- 8.82%, respectively). This study shows that intestinal permeability increased in cirrhotic patients regardless of the grade and aetiology of disease. The presence of SBP does not seem to be due to increased intestinal permeability.