Intestinal permeability in liver cirrhosis: relationship with severe septic complications

Objectives Patients with liver cirrhosis are at high risk of severe septic complications such as spontaneous bacterial peritonitis (SBP) and bacteraem ia, The aims of this study were to assess intestinal permeability in patien ts with liver cirrhosis and to search for a relationship between an impaire d intestinal permeability and the occurrence of severe septic complications . Methods Intestinal permeability was assessed in a group of 80 cirrhotic pat ients (Child A, n = 13; Child B, n = 26; Child C, n = 41) and 28 healthy co ntrol subjects. A severe septic complication (bacteraemia and/or SEP) occur red in 16 patients, within 10 days before (n = 8 cases) or after (n = 8 cas es) the test was performed. Lactulose (LAC) 10 g was given orally together with mannitol (MAN) 5 g, and urinary excretion rates were determined. Results Urinary mannitol excretion (MAN%) was lower while the LAC/MAN ratio was higher in patients than in control subjects (P < 0.001); these abnorma lities were more marked in Child C patients (Child C patients vs control su bjects: MAN%, 8.20 +/- 0.79 vs 14.59 +/- 0.58, P < 0.001; LAC/MAN, 0.066 +/ - 0.026 vs 0.017 +/- 0.001, P < 0.02). When compared with non-infected pati ents, septic patients had a lower MAN% and an increased LAC/MAN ratio (5.45 +/- 1.12 vs 9.83 +/- 0.87, P < 0.02; 0.130 +/- 0.063 vs 0.029 +/- 0.005, P < 0.02), Conclusion Although the main mechanism involved in the decrease in MAN% is likely a reduction in area of the intestinal absorptive surface, these resu lts argue in favour of an increased intestinal permeability in liver cirrho sis, especially in patients with severe infectious complications. The impai rment of intestinal function barrier may contribute to severe septic compli cations in these patients. Eur J Gastroenterol Hepatol 11:755-759 (C) 1999 Lippincott Williams & Wilkins.