ENDOTOXEMIA AND MEDIATOR RELEASE DURING COLONOSCOPY

Background and Study Aims: Previous clinical and experimental studies have shown evidence of a leakage of whole bacteria and bacterial produ cts after major trauma through the gut barrier, By determining plasma endotoxin levels, products of the arachidonic pathway, interleukin-6, and the endotoxin-neutralizing capacity (ENC) of plasma during colonos copy, we studied the gut barrier function and the pathogenetic sequela e of mediator release during a minimally invasive procedure. Patients and Methods: Thirty-two patients were enrolled in a controlled prospec tive study, Endotoxin and ENC were determined by a chromogenic modific ation of the limulus amebocyte lysate test, Prostanoids and interleuki n-6 were measured using commercially available ELISA tests, C-reactive protein levels were checked by nephelometry. Results: Twenty-one of t he 32 patients had elevated endotoxin plasma levels during colonoscopy , In one patient, gut-derived bacteria were detected in plasma, ENC de creased after 5 min, and thromboxane Bz levels also started to increas e at that time, No acute-phase response took place after 24 h. Conclus ion: During colonoscopy, endotoxin can be detected in blood, ENC measu rement was shown to be even more sensitive, The pathogenetic sequelae leading to gut barrier failure remain unclear, because mediator releas e and endotoxemia, as checked by ENC, took place simultaneously.