The effects of sodium deoxycholate, lactulose and glutamine on bacterial translocation in common bile duct ligated rats

BACKGROUND/AIMS: Sepsis is a major cause of post-operative morbidity and mo rtality in obstructive jaundice as a result of bacterial translocation from the gut. This study was conducted to investigate the effects of glutamine, lactulose, and the bile salt Na deoxycholate in preventing bacterial trans location in an animal model where obstructive jaundice was developed by com mon bile duct ligation. METHODOLOGY: Fifty Wistar albino rats were divided into 5 groups of 10 anim als each. The animals in groups I-IV underwent common bile duct ligation an d received, respectively, either saline, Na deoxycholate, lactulose or glut amine, orally. Group V had sham ligation and received saline orally. The an imals were sacrificed at the end of the 7th day, and serum concentrations o f bilirubin, aspartate aminotransferase (ALT), alanine aminotransferase (AL T), and alkaline phosphatase (AP) were measured. In addition, mesenteric ly mph nodes were removed and cultured together with cecal content. Histopatho logic examination of terminal ileum specimens was made. RESULTS: Na deoxycholate, lactulose and glutamine all reduced bacterial tra nslocation rates to mesenteric lymph nodes (p<0.05), with glutamine causing the greatest effect. Na deoxycholate and lactulose prevented bacterial tra nslocation by causing a decrease in cecal intraluminal bacterial content (p <0.001), while glutamine exerted its effect by preserving intestinal mucosa l integrity. CONCLUSIONS: The integrity of the intestinal mucosal barrier is of paramoun t importance in preventing bacterial translocation, and the measures taken to protect mucosal integrity reduce bacterial translocation to a greater ex tent than those taken to decrease the number of bacteria in the gut.