Increased intestinal permeability in malnourished patients with liver cirrhosis

Abstract

BACKGROUND/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. SUBJECTS/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 ¼ 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.

Alterations of gut barrier and gut microbiota in food restriction, food deprivation and protein-energy wasting

“…Plasma Giardia-specific-IgM were only measured in the infants from Bangladesh, and occurred in 98% of them. PEW was also associated with decreased small bowel permeability (L:M ratio), in hospitalized adults [33] and patients with liver cirrhosis [51]. Interestingly, Hulsewe et al could not reproduce these results in 26 patients requiring preoperative total parenteral nutrition (TPN) [52].…”

A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

“…Malnutrition is a commonly precipitating state among cirrhotic patients, and its prevalence might be even 80% [3]. Moreover, poor absorption (especially in patients with coexisting bile duct diseases) and increased gastrointestinal permeability are also involved [4]. In consequence, because of the deterioration in the storage of nutrients and altered hepatic synthesis, hypoalbuminemia occurs.…”

Changes of Intestinal Functions in Liver Cirrhosis

“…In an Italian study, intestinal hyperpermeability has been shown to be more common in patients with a history of SBP [68]; in a Korean study, it was considered to be a predictor of bacterial infections in cirrhosis [75]. Four studies, 3 from the Western world (Spain, USA and Italy) and 1 from China [68,70,76,77], reported a significantly higher intestinal permeability in cirrhotic patients with ascites, although other studies did not observe a significant difference [67,69,73,78,79,80]. Contrasting results have been reported on the association between intestinal permeability and HE as well [67].…”