title: Increased intestinal permeability in malnourished patients with liver cirrhosis.
abstract: OBJECTIVE
  Malnutrition is a prominent feature in liver cirrhosis, with deleterious impact on clinical outcome. The objective of this study is to investigate whether malnutrition is associated with increased gastrointestinal permeability in liver cirrhosis reflected by altered urinary excretion of non-metabolizable sugar probes.
  
  
  METHODS
  Patients with advanced liver cirrhosis (Child Pugh Score B or C) were recruited. Nutritional status was determined according to the Subjective Global Assessment. Intestinal permeability was assessed by measuring the urinary excretion of orally administered, non-metabolized sugar probe molecules. The lactulose/mannitol ratio served as marker for intestinal permeability and reflects non-carrier-mediated transcellular and paracellular transport of the small intestine during the first 5 h. Sucrose recovery in urine within the first 5 h reflects gastroduodenal permeability; sucralose recovery in urine 5-26 h after consumption reflects colonic permeability.
  
  
  RESULTS
  Sixty-four patients (56.7±10.8 years; 33% female) were included in the study. Twenty-one patients were considered well nourished according to the Subjective Global Assessment, 23 moderately nourished and 20 patients severely malnourished; 74% had alcoholic liver disease and 67% had cirrhosis stage Child C. Gastroduodenal and colonic permeability was significantly increased in patients with liver cirrhosis compared with 63 healthy controls (0.23±0.22 and 1.37±1.42% vs 0.14±0.10 and 0.41±0.72% in controls), but not different between well and malnourished subjects. Small intestinal permeability (lactulose/mannitol ratio) was increased in all patients (0.069±0.055%) and further increased in malnourished patients (0.048±0.031% vs 0.084±0.061%, P=0.004) due to decreased mannitol recovery only.
  
  
  CONCLUSIONS
  Gastric, small intestinal and even colonic permeability was altogether increased in liver cirrhosis, and malnutrition was associated with further increased small intestinal permeability indicative of villous atrophy.
authors.affiliation: Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie-Einschl. Arbeitsbereich Ernährungsmedizin, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany. kristina.norman@charite.de
authors.forename: K
authors.initials: K
authors.lastname: Norman
authors.forename: M
authors.initials: M
authors.lastname: Pirlich
authors.forename: J-D
authors.initials: JD
authors.lastname: Schulzke
authors.forename: C
authors.initials: C
authors.lastname: Smoliner
authors.forename: H
authors.initials: H
authors.lastname: Lochs
authors.forename: L
authors.initials: L
authors.lastname: Valentini
authors.forename: S
authors.initials: S
authors.lastname: Bühner
mesh_terms: D000368:Aged; D001284:Atrophy; D019422:Dietary Sucrose / Q000008:administration & dosage / Q000652:urine; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism* / Q000473:pathology; D041981:Gastrointestinal Tract / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000473:pathology; D007792:Lactulose / Q000008:administration & dosage / Q000652:urine; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D008353:Mannitol / Q000008:administration & dosage / Q000652:urine; D008875:Middle Aged; D015596:Nutrition Assessment; D009928:Organ Specificity; D010539:Permeability; D012720:Severity of Illness Index
chemical_list: D019422:Dietary Sucrose; D008353:Mannitol; D007792:Lactulose