GUT BARRIER FUNCTION IN MALNOURISHED PATIENTS

Background-The integrity of the gastrointestinal mucosa is a kev eleme nt in preventing systemic absorption of enteric toxins and bacteria. I n the critically ill, breakdown of gut barrier function may fuel sepsi s. Malnourished patients have an increased risk of postoperative sepsi s; however, the effects of malnutrition on intestinal barrier function in man are unknown. Aims-To quantify intestinal barrier function, end otoxin exposure, and the acute phase cytokine response in malnourished patients. Patients-Malnourished and well nourished hospitalised patie nts. Methods-Gastrointestinal permeability was measured in malnourishe d patients and well nourished controls using the lactulose:mannitol te st. Endoscopic biopsy specimens were stained and morphological and imm unohistochemical features graded. The polymerase chain reaction was us ed to determine mucosal cytokine expression. The immunoglobulin G anti body response to endotoxin and serum interleukin 6 were measured by en zyme linked immunosorbent assay. Results-There was a significant incre ase in intestinal permeability in the malnourished patients in associa tion with phenotypic and molecular evidence of activation of lamina pr opria mononuclear cells and enterocytes, and a heightened acute phase response. Conclusions-Intestinal barrier function is significantly com promised in malnourished patients, but the clinical significance is un clear.