title: Effect of long-term acid gastric inhibition on bacterial translocation in cirrhotic rats.
abstract: BACKGROUND
  Bacterial translocation (BT) related to intestinal bacterial overgrowth (IBO) plays an important role in the pathogenesis of bacterial infections in cirrhosis. Inhibition of acid gastric secretion promotes IBO and might favor BT. We evaluated the effect of long-term inhibition of acid gastric secretion on BT in cirrhotic rats.
  
  
  METHODS
  Cirrhotic rats with and without ascites induced by oral CCl4 and controls were randomized to treatment with a daily subcutaneous injection of placebo, ranitidine (50 mg/kg), or pantoprazole (8 mg/kg) during 2 weeks. Continuous pH-metry was performed for 2 h before and at the end of treatment; thereafter, a laparotomy to obtain samples of blood, mesenteric lymph nodes, ascites, spleen, liver, and cecal stools was performed.
  
  
  RESULTS
  Ranitidine and pantoprazole increased gastric pH as compared with placebo (P<0.001). However, antisecretory drugs increased the incidence of BT only in ascitic rats treated with ranitidine (P<0.05) or pantoprazole (P=0.07) when compared with placebo-treated ascitic rats or cirrhotic rats without ascites treated with the same drug. Cirrhotic ascitic rats treated with pantoprazole showed a trend toward an increased incidence of IBO (P=0.08), a higher ileal malondialdehyde level (P<0.01), and an increased production of tumor necrosis factor-α (P<0.05).
  
  
  CONCLUSIONS
  Although inhibition of acid gastric secretion increased gastric pH in all animals, the incidence of BT increased only in ascitic rats, and it was associated with a trend toward an increase in IBO incidence, a higher ileal malondialdehyde level, and an increased production of serum tumor necrosis factor-α. Therefore, antisecretory drugs should be carefully administered to cirrhotic ascitic patients.
authors.affiliation: Departments of aGastroenterology, Liver Unit bMicrobiology cImmunology, Hospital de la Santa Creu i Sant Pau dInstitut d´Investigacions Biomédiques de Sant Pau (IIB) eUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona fCentro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Sánchez
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mirelis
authors.forename: Begoña
authors.initials: B
authors.lastname: Gonzalez
authors.forename: Juan C
authors.initials: JC
authors.lastname: Nieto
authors.forename: Silvia
authors.initials: S
authors.lastname: Vidal
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
authors.forename: Cándido
authors.initials: C
authors.lastname: Juárez
authors.forename: Joan
authors.initials: J
authors.lastname: Monés
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000494:pharmacology; D000818:Animals; D000897:Anti-Ulcer Agents / Q000494:pharmacology*; D001201:Ascites / Q000209:etiology; D018988:Bacterial Translocation / Q000187:drug effects*; D001765:Blind Loop Syndrome / Q000139:chemically induced / Q000382:microbiology*; D005744:Gastric Acid / Q000737:chemistry / Q000378:metabolism*; D005753:Gastric Mucosa / Q000187:drug effects* / Q000378:metabolism; D000069196:Gastrointestinal Microbiome / Q000187:drug effects; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007082:Ileum / Q000737:chemistry; D007413:Intestinal Mucosa / Q000737:chemistry / Q000187:drug effects; D008106:Liver Cirrhosis, Experimental / Q000097:blood / Q000150:complications*; D008297:Male; D008315:Malondialdehyde / Q000032:analysis; D000077402:Pantoprazole; D011899:Ranitidine / Q000494:pharmacology; D051381:Rats; D017207:Rats, Sprague-Dawley; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D014409:Tumor Necrosis Factor-alpha; D008315:Malondialdehyde; D011899:Ranitidine; D000077402:Pantoprazole