GASTROINTESTINAL PERMEABILITY AND ABSORPTIVE-CAPACITY IN SEPSIS

Objective: To assess gastrointestinal permeability and functional abso rptive capacity in patients with sepsis. Design: Case control study to analyze gastrointestinal permeability ability and functional absorpti ve capacity of septic patients by differential saccharide absorption ( from an oral test solution) and excretion. Setting: The Intensive Ther apy Unit of St, Thomas' Hospital, London, UK. Patients: Twenty patient s with a mean Acute Physiology and Chronic Health Evaluation (APACHE) II score of 18.4 who were admitted to the intensive care unit with a d iagnosis of sepsis. All patients were on enteral feeding. Patients wit h abdominal pathology were excluded. Interventions: An oral test solut ion containing 5 g of lactulose, 1 g of L-rhamnose, 0.5 g of D-xylose, and 0.2 g of 3-O-methyl-D-glucose dissolved in water to a final volum e of 100 mt was administered to patients and controls. Urine was colle cted for 5 hrs starting immediately after administration of the test s olution and the saccharide content of the urine was estimated and expr essed as a percentage recovery of the oral test solution. Measurements and Main Results: Septic patients had increased lactulose/L-rhamnose urine excretion ratios (0.23 +/- 0.19) compared with control subjects (0.03 +/- 0.01, p < .001), consistent with increased gastrointestinal permeability in sepsis. Septic patients had decreased L rhamnose/3-O-m ethyl-D-glucose urine excretion ratios (0.14 +/- 0.07) compared with n ormal controls (0.28 +/- 0.08, p < .001), consistent with decreased ga strointestinal functional absorptive capacity in sepsis, Conclusions: Patients with acute sepsis exhibit increased gastrointestinal permeabi lity and decreased gastrointestinal functional absorptive capacity in comparison with healthy control subjects. These abnormalities may cont ribute to the pathophysiology of sepsis.