[Gastrointestinal dysfunction in acute severe mountain sickness and its relation with multiple organ dysfunction syndrome].
OBJECTIVE
To investigate the relationship between gastrointestinal dysfunction (GD) and multiple organ dysfunction syndrome (MODS) in acute severe mountain sickness (ASMS), including high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE), by a retrospective study of medical records and prospective study of hospitalized patients.


METHODS
In retrospective study, the clinical data of 3 184 inpatients of General Hospital of Tibetan Military Command suffering from ASMS in the past 50 years (from June, 1958 to June, 2007) were collected. Statistical analysis was performed to study the relationship between GD and MODS in these patients. For the prospective study, 10 admitted patients of ASMS were included. Gastroscopic examination was performed for the ASMS patients, and gastric and duodenal mucosa was scrutinized. At the same time, 30 g of glutamine (Gln) capsule was orally ingested each day for 3 days after the first day of admission. Ten healthy volunteers were included in the control group, and received the same treatment. The levels of serum diamine oxidase (DAO), malonic dialdehyde (MDA), endotoxin and lactulose/mannitol (L/M) ratio were detected before and after treatment in two groups.


RESULTS
First, 49.8% of the patients with ASMS were complicated with GD, with 1.5% of fairy stool, and 1.0% with occult blood in stool. In 83 cases of ASMS complicated with MODS, 21.7% (18 cases) appeared GD, and the score of GD was 5.5 in the total score of all organ injury. Second, endoscopic examination showed extensive edema and localized hemorrhage in gastrointestinal mucous membrane, with dotted and patched erosion in gastric antrum and fundus. The pre-treatment DAO, MDA, and endotoxin were higher in the observation group than those in the control group (all P<0.01). After 3 days of Gln capsule treatment, DAO, MDA, and endotoxin were significantly decreased in the observation group (P<0.05 or P<0.01). The pre-treatment L/M ratio in observation group was significantly higher than that in healthy control group (150.69+/-19.91 vs. 117.91+/-17.78, P<0.01). The L/M ratio was significantly decreased after the treatment, as it decreased to 129.37+/-19.75 (P<0.05). However, no significant change in the healthy control group was observed.


CONCLUSIONS
GD plays a major role in the pathogenesis of MODS in ASMS patients.
Yang
Ding-zhou
DZ
Department of High Altitude Disease, High Altitude Medicine College, Third Military Medical University, Chongqing 400038, China.
Zhou
Qi-quan
QQ
Li
Su-zhi
SZ
Zheng
Bi-hai
BH
Gao
Yu-qi
YQ
Jiang
Shao-hua
SH
Huang
Xue-wen
XW
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000532:Altitude Sickness / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D006631:Amine Oxidase (Copper-Containing) / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004731:Endotoxins / Q000097:blood; D005260:Female; D041981:Gastrointestinal Tract / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
D004731:Endotoxins; D006631:Amine Oxidase (Copper-Containing)