Intestinal permeability increases with the severity of abdominal trauma: Acomparison between gas liquid chromatographic and enzymatic method

Background/Aims: Increased intestinal permeability was found in humans afte r multiple trauma, burn injury and major vascular surgery. However, no data are reported regarding possible correlation between trauma and intestinal permeability degree. This study was undertaken to compare gas-liquid chroma tographic and enzymatic method for the evaluation of intestinal permeabilit y impairment in patients after severe abdominal trauma. Methodology: Five traumatized patients with an injury severity score of mor e than 24 and 5 crossmatched healthy volunteers were studied. The intestina l permeability was performed using a test solution, containing 10g lactulos e and Sg mannitol. Gas-liquid chromatographic method was applied to measure sugar standards and 6-hour urine samples and the results were compared wit h those obtained employing a specific enzymatic method. Results: Linearity of myoinositol, lactulose and mannitol measured by gas-l iquid chromatographic method was from 0.2-1 mu g injected. Using the enzyma tic method, the response was linear between mannitol concentrations of 0.34 and 5.49mM. Linearity of lactulose standard was from 0.18-2.92mM. The gas- liquid chromatographic and enzymatic methods showed a good agreement using the Bland-Altman procedure. The mean lactulose/mannitol ratio was 0.085+/-0 .025 in patients and 0.009+/-0.001 in controls (P<0.001). The higher the in jury severity score (30.8+/-5) the larger the ratio of lactulose to mannito l (R-2=0.74). Conclusions: The enzymatic method - inexpensive, easy-to-perform and timesa ving - is suitable for intestinal permeability studies. An abdominal trauma , without injury requiring surgical operation, modifies the intestinal muco sa permeability possibly favoring passage of bacteria and subsequent sepsis .