Gut barrier function in malnourished patients.
BACKGROUND
The integrity of the gastrointestinal mucosa is a key element in preventing systemic absorption of enteric toxins and bacteria. In the critically ill, breakdown of gut barrier function may fuel sepsis. Malnourished patients have an increased risk of postoperative sepsis; however, the effects of malnutrition on intestinal barrier function in man are unknown.


OBJECTIVE
To quantify intestinal barrier function, endotoxin exposure, and the acute phase cytokine response in malnourished patients.


METHODS
Malnourished and well nourished hospitalised patients.


METHODS
Gastrointestinal permeability was measured in malnourished patients and well nourished controls using the lactulose:mannitol test. Endoscopic biopsy specimens were stained and morphological and immunohistochemical features graded. The polymerase chain reaction was used to determine mucosal cytokine expression. The immunoglobulin G antibody response to endotoxin and serum interleukin 6 were measured by enzyme linked immunosorbent assay.


RESULTS
There was a significant increase in intestinal permeability in the malnourished patients in association with phenotypic and molecular evidence of activation of lamina propria mononuclear cells and enterocytes, and a heightened acute phase response.


CONCLUSIONS
Intestinal barrier function is significantly compromised in malnourished patients, but the clinical significance is unclear.
Welsh
F K
FK
Department of Pathology, St James's University Hospital, Leeds, United Kingdom.
Farmery
S M
SM
MacLennan
K
K
Sheridan
M B
MB
Barclay
G R
GR
Guillou
P J
PJ
Reynolds
J V
JV
D000368:Aged; D004731:Endotoxins / Q000494:pharmacology; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007150:Immunohistochemistry; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D016133:Polymerase Chain Reaction
D004731:Endotoxins; D006684:HLA-DR Antigens; D007074:Immunoglobulin G; D015850:Interleukin-6; D016753:Interleukin-10