Intestinal permeability is increased in patients with advanced cirrhosis.
OBJECTIVE
The dysfunction of the intestinal barrier is a factor that has been related to bacterial translocation from lumen to extra-intestinal sites and consequently to the development of spontaneous bacterial peritonitis. The aim of this study was to investigate if the alterations of the intestinal barrier in cirrhosis are related with the degree of liver failure and associated with other clinical complications.


METHODS
Intestinal permeability was assessed by means of the lactulose/mannitol test in 79 cirrhotic and 25 controls subjects. They received 10 g of lactulose and 5 g of mannitol. Lactulose and mannitol were measured in a five-hour urinary volume.


RESULTS
Lactulose/mannitol ratio was significantly higher in cirrhotic patients than in controls (p = 0.03). This was more evident in end-stage cirrhosis. Patients with ascites, or encephalopathy showed a statistically significant increase in lactulose/mannitol ratio when compared to patients without these complications.


CONCLUSIONS
The increased intestinal permeability is related to the progression of the liver disease and is more relevant with overt clinical complications. This is due to an increased absorption of lactulose. However, as liver disease progresses, mannitol absorption is progressively reduced, probably due to a reduced surface of absorption, and these events are more relevant in patients with overt clinical complications.
Liver Unit, Department of Internal Medicine, University General Hospital of Alicante C/Pintor Baeza s/n, Alicante 03010, Spain. pascual_son@gva.es
Sonia
S
Pascual
José
J
Such
Angel
A
Esteban
Pedro
P
Zapater
Juan A
JA
Casellas
José R
JR
Aparicio
Eva
E
Girona
Ana
A
Gutiérrez
Fernando
F
Carnices
Jose M
JM
Palazón
Javier
J
Sola-Vera
Miguel
M
Pérez-Mateo
D018450:Disease Progression; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D007422:Intestines / Q000503:physiopathology*; D007792:Lactulose; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000503:physiopathology
D005765:Gastrointestinal Agents; D007792:Lactulose