EFFECT OF HUMAN BOWEL WALL DISTENSION ON TRANSLOCATION OF INDIGENOUS BACTERIA AND ENDOTOXINS

The effect of colonic distension on the translocation of indigenous ba cteria and endotaxins was prospectively assessed in 50 consecutive pat ients undergoing colonoscopy. Semiquantitative bacteriologic cultures, chromogenic LAL testing for endotoxemia, and serial determinations of inflammatory markers were used. At the end of the endoscopic procedur e, true bacteremia was found in only two patients with obstructing col orectal cancer. There was no evidence of systemic endotoxemia either b eing induced or increased during the observation period. The endotoxin detoxifying plasma capacity was elevated in patients with preexisting inflammation and did not change within this period. Levels of TNF-alp ha, interleukin-6 (IL-6), and elastase (Ealpha1PI) did not differ from baseline values. C3a levels increased in 20% of the patients, whereas fibrinopeptide A values rose by up to 10(2) during colonoscopy. Howev er, since neither endotoxin, TNFalpha, nor IL-6 levels were found to b e elevated in this study, the excessive activation of the coagulation system must be related to the distension of bowel wall vessels rather than to an effect of endotoxins escaping from the lumen.