title: The role of the gut barrier function in the pathophysiology of viral liver cirrhosis.
abstract: OBJECTIVE
  Plasma endotoxin levels commonly increase in patients with liver cirrhosis. We purposed to identify change of intestinal permeability and frequency of endotoxemia in patients with viral liver cirrhosis. Additionally, we studied the relationship between plasma endotoxin levels and failure of gut barrier function.
  
  
  METHODS
  Subjects included 27 patients with viral liver cirrhosis (LC) and 45 volunteers as healthy control (HC). Intestinal permeability index was determined by the level of urinary excretion of polyethylene-glycol after oral administration and plasma endotoxin levels by using quantitative Limulus assay. Grades of liver dysfunction were categorized by Child-Pugh classification and MELD score.
  
  
  RESULTS
  Intestinal permeability indexes were higher in LC than in HC (1.48±0.56%, n=27 vs. 0.93±0.50%, n=45, p=0.019). Plasma endotoxin levels were higher in LC than in HC (0.35±0.17EU/ mL vs. 0.11±0.14EU/mL, p<0.001). In LC, plasma endotoxin levels progressively increased in relation to severity of liver dysfunction (Child-Pugh class A (0.31±0.17EU/mL), B (0.37±0.14EU/mL) and C (0.42±0.23EU/mL), p=0.013, MELD category 1/2/3/4=0.27±0.14/0.39±0.17/0.32±0.21/0.47±0.28E U/mL, p=0.043). LC with/without portal hypertension (1.47±0.55%, p<0.01/1.29±0.59%, p<0.05) had higher intestinal permeability indexes than HC (0.93±0.50%).
  
  
  CONCLUSIONS
  Severity of liver dysfunction was associated with endotoxemia. Although gut barrier function did not show a significant relationship with endotoxemia, increased intestinal permeability may be a significant finding that at least in part is associated with the pathophysiology of viral liver cirrhosis.
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Korea.
authors.forename: Yeowon
authors.initials: Y
authors.lastname: Choi
authors.forename: Woo Kyu
authors.initials: WK
authors.lastname: Jeon
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
authors.forename: Chong Il
authors.initials: CI
authors.lastname: Sohn
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Hong Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D004731:Endotoxins / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000378:metabolism*; D006526:Hepatitis C / Q000378:metabolism*; D006801:Humans; D006975:Hypertension, Portal / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010539:Permeability
chemical_list: D004731:Endotoxins