INTESTINAL BARRIER DYSFUNCTION IN CLINICAL AND EXPERIMENTAL OBSTRUCTIVE-JAUNDICE AND ITS REVERSAL BY INTERNAL BILIARY DRAINAGE

Intestinal mucosal barrier function in obstructive jaundice was assess ed in an animal model and in patients. The effect of internal biliary drainage in patients was also examined. Bile duct ligation for 1 week in the rat resulted in significant bacterial translocation (in seven o f 12 animals following ligation versus none of the sham-operated contr ols, P<0.01). Intestinal permeability, measured by the urinary recover y of orally administered polyethylene glycol, was also significantly i ncreased (+66.2 per cent for ligation versus -11.6 per cent for sham, P<0.01). A prospective study was performed on 33 patients with obstruc tive jaundice undergoing internal biliary drainage, and results were c ompared with those in six non-jaundiced patients undergoing laparotomy or endoscopic retrograde cholangiopancreatography and in 11 healthy v olunteers. The lactulose:mannitol ratio was used as an intestinal perm eability index. Mean(s.e.m.) intestinal permeability assessed before o peration was significantly increased in jaundiced patients compared wi th control patients (0.050(0.010) versus 0.016(0.003), P<0.005). The m ean(s.e.m.) lactulose:mannitol ratio in the healthy volunteers was 0.0 20(0.003), which was similar to that in control patients. In the jaund iced group of patients the intestinal permeability index fell to withi n normal levels after 28 days of internal biliary drainage (0.050 befo re operation versus 0.021 at 28 days, P<0.02). These data indicate tha t intestinal barrier function is impaired in obstructive jaundice and that this impairment is reversed by return of bile to the gastrointest inal tract.