Systemic endotoxaemia following obstructive jaundice: the role of lactulose.
BACKGROUND
Obstructive jaundice is often accompanied by bacterial translocation and subsequent sepsis. The effect of lactulose in preventing that process was evaluated in an experimental model. Obstructive jaundice was induced in 23 rabbits after common bile duct ligation.


METHODS
Animals were divided into two groups. Group A of 11 animals-controls and group B of 12 rabbits, which received 2 ml/kg of lactulose p.o. by a nasogastric tube. Blood was sampled daily, before and after operation. Samples were applied for culture and for estimation of endotoxins (LPS), tumor necrosis factor (TNFa), and malondialdehyde (MDA).


RESULTS
Mean (+/-SD) survival of animals of group A was 3.08+/-0.19 days compared to 5.36+/-0.41 days of animals of group B. Serum concentrations of LPS and TNFa of each day of treatment remain constant in animals of group A; they were steadily decreased in animals of group B reaching statistical significance on the fourth day. Similar changes were not found for MDA.


CONCLUSIONS
The administration of lactulose may prevent systemic endotoxaemia and the subsequent inflammatory response in an experimental model of obstructive jaundice, so as to extend survival. These results merit further clinical evaluation.
Koutelidakis
Ioannis
I
2nd Department of Surgery, Aristotelio University of Thessaloniki Medical School, Thessaloniki, Greece. iokoutel@med.auth.gr
Papaziogas
Basilios
B
Giamarellos-Bourboulis
Evangelos J
EJ
Makris
John
J
Pavlidis
Theodoros
T
Giamarellou
Helen
H
Papaziogas
Thomas
T
D000208:Acute Disease; D000818:Animals; D018988:Bacterial Translocation / Q000187:drug effects*; D002761:Cholangitis / Q000209:etiology; D002779:Cholestasis / Q000209:etiology; D003135:Common Bile Duct / Q000601:surgery; D019446:Endotoxemia / Q000209:etiology / Q000517:prevention & control*; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D007792:Lactulose / Q000494:pharmacology*; D008026:Ligation / Q000009:adverse effects; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D023421:Models, Animal; D011817:Rabbits; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D005765:Gastrointestinal Agents; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D007792:Lactulose; D008315:Malondialdehyde