Intestinal permeability in patients with liver cirrhosis

Abstract EN

Aim: This study was designed to evaluate the intestinal permeability in patients with liver cirrhosis and its relation to portal hypertension, hepatic encephalopathy and spontaneous bacterial peritonitis.

Patients and Methods: The study included 46 adult inpatients with liver cirrhosis.

Another group of 12 age matched normal individuals as a control group were studied The diagnosis was based on clinical, ultrasonographic, bioghemical and endoscopic criteria According to modified Child-Pough classification, the patients were divided into 3 groups, 12 patients ofChild A, 15 patients of Child B and 19 patients of Child C.

Thirty four patients had portal hypertension, 6 patients had (Sponteous bacterial peritonitis) SSBP and 10 patients had encephalopathy.

Studies for intestinal mucosal permeability were done for patients and control groups using 5 hours urinary excretion ratio of lactulose and L-rhamnose.

Results: The cirrhotic patients showed increase in the mean value of (La/rham) ratio compared to controls and the increase was statistically significant.

There was progressive increase in the mean urinary excretion of La/rham ratio reflecting increased intestinal permeability in cirrhotic patients from Child class AtoBtoC compared to control and the differences were statistically significant.

Cirrhotic patients with hepatic encephalopathy showed significant increase in the mean (La/rham) excretion compared with the controls and with cirrhotic patients without hepatic encephalopathy.

Cirrhotic patients with portal hypertension showed significant increase in the mean (La/rham) excretion in comparison to controls and cirrhotic patients without portal hypertension.

Patients with spontaneous bacterial peritonitis showed significant increase in the mean (La/rham) excretion compared with the control and with cirrhotic patients without spontaneous bacterial peritonitis.

Conclusion: we can conclude that: 1) Intestinal mucosal permeability is increased in patients with liver cirrhosis and the increase in permeability is related to the severity of cirrhosis.

2) Cirrhotic patients with portal hypertension have an increase in intestinal mucosal permeability as portal hypertension causes alteration of the tight junctions.

3) The increase in intestinal mucosal permeability may facilitate translocation of bacteria secondary to increased intestinal bacterial overgrowth in patients with liver cirrhosis.