Barrier Function of the Gut and Multiple Organ Dysfunction after Cardiac Surgery

Abstract

72We studied the influence of sequential involvement of the gastrointestinal (GI) tract on the development of multiple organ dysfunction (MOD) after cardiopulmonary bypass (CPB). One hundred and forty-six patients undergoing elective cardiac surgery were included in this prospective observational study. Standardized oral inert-sugar tests (sucrose, lactulose, mannitol, sucralose) were performed before and after CPB in different patients. Enzyme-linked immunosorbent assay of plasma levels of endotoxin core antibodies (EndoCAb) were performed peri-operatively. The functional mucosal surface was calculated from the amount of mannitol absorbed from the GI tract. Lower urine concentrations of absorbed mannitol were observed preoperatively in patients developing MOD. In binary logistic regression this was an independent parameter. Decreased plasma concentrations of EndoCAb after surgery were seen in every patient, but were more significant in patients developing MOD. A reduced pre-operative functional mucosal surface may predict the early occurrence of MOD after surgery.

Recipient’s Genetic R702W NOD2 Variant Is Associated with an Increased Risk of Bacterial Infections after Orthotopic Liver Transplantation

“…NOD2 is a critical component of the intestinal immunological barrier. In the initial period after transplantation this intestinal barrier is already compromised due to the postoperative state of the patient [18,19]. Furthermore, bacterial translocation in cirrhosis is increased due to structural changes of the intestinal mucosa, including dilatation of intercellular space and vascular congestion as well as mucosal oxidative damage [20], and probably these structural changes also contribute to a decreased barrier function during the recovery phase of the gut post transplantation.…”

Clinical relevance of measuring colonic permeability

“…Using permeability tests in combination with endoscopic investigations, gastroduodenal and small bowel hyperpermeability have long ago been demonstrated in high proportions of patients with Crohn's disease (CD) [1,2]. Concomitantly after cardiac surgery, drastic permeability increases have been linked with translocation of intestinal bacteria, bacteremic complications and worsening of postoperative outcome [3,4]. The traditional sugars described above are degraded by colonic bacteria, and while permitting the assessment of gastroduodenal and small intestinal permeability, colonic damage could stay unnoticed.…”

New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery

“…Studies in patients undergoing major gastro-intestinal, cardiac or vascular surgery, investigating the role of the gut in the development of postoperative complications, are largely restricted to data on increased intestinal permeability for sugars, 51 Cr-EDTA and the circulatory levels of endotoxin [11]–[19]. Several authors report changes in these parameters in patients following major surgery, indicating that the gut barrier is injured [11]–[14].…”

“…Several authors report changes in these parameters in patients following major surgery, indicating that the gut barrier is injured [11]–[14]. However, other reports using these tests lack to support these data [15]–[18].…”