Investigation of intestine and liver function in cirrhosis using combined sugar oral loads

Budillon, G; Parrilli, G.; Pacella, Massimo; Cuomo, Rosario; Menzies, Ian S.

doi:10.1016/s0168-8278(85)80749-2

Cited by 36 publications

(15 citation statements)

References 37 publications

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“…Apparent discrepancies in results between the current and previous studies (in many of which patients with ongoing infections such as spontaneous bacterial peritonitis were included) may partly be explained by differences in patient selection [28,29,[93][94][95][96][97][98]. However, one of the most informative studies by Zuckerman et al evaluated intestinal permeability in liver cirrhosis with and without ascites with a differential four-sugar intestinal permeability-absorption test [98].…”

Section: Intestinal Permeability (Iv)mentioning

confidence: 91%

“…Increased intestinal permeability is evident in a number of conditions associated with bacterial translocation and/or endotoxemia [82][83][84]. Intestinal permeability in liver cirrhosis has been variously reported as increased or normal [28,29,[93][94][95][96][97][98]. However, limited data exists on the state of intestinal permeability in patients with cirrhosis and ascites (who are at risk of developing spontaneous bacterial peritonitis) or the effect of paracentesis.…”

Section: Intestinal Permeabilitymentioning

confidence: 99%

“…A number of investigators have observed normal intestinal permeability in patients with liver cirrhosis [29,95,97], whereas others have found intestinal permeability to be increased [28,93,94,96]. Limited data exists on the influence of ascites per se on intestinal permeability in liver cirrhosis and the impact of paracentesis has not been previously explored.…”

Section: Intestinal Permeability (Iv)mentioning

confidence: 99%

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Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

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Malnutrition is a common finding in patients with liver cirrhosis. Malnutrition has been shown to be associated with increased morbidity and mortality. Its pathogenesis remains unclear but both poor dietary intake and increased energy expenditure have been reported.Spontaneous bacterial peritonitis is an important clinical problem in cirrhotics. It may occur as a consequence of repeated access of bacteria from the intestinal lumen (translocation) to the mesenteric lymph nodes. One of the mechanisms proposed to explain bacterial translocation in cirrhosis includes increased intestinal permeability.The aims of the present study were to evaluate GI symptoms in cirrhotic patients and their possible relation to nutritional status, to assess whether gastric sensorimotor dysfunction or metabolic disturbances are associated with reduced food intake, and to investigate the role of ascites in intestinal permeability in patients with liver cirrhosis.Gastrointestinal symptoms and health-related quality of life (HRQOL) were assessed with the aid of two questionnaires. Gastric sensorimotor function was measured by means of an electronic barostat. Food intake, as assessed with a food diary, was related to fasting and postprandial glucose, insulin, leptin, and ghrelin concentrations. Intestinal permeability was evaluated by a 51 Cr-EDTA permeability test. Cirrhotics were found to have increased severity of GI symptoms compared with reference values from the general population. A relationship between GI symptoms and compromised HRQOL as well as weight loss was observed.Proximal stomach relaxation to a meal was increased in patients with liver cirrhosis as compared with healthy controls but the relation between gastric accommodation and energy intake was found to be disturbed in these patients. Gastric sensitivity to distension was shown to be related to GI symptom severity and to liver cirrhosis severity scores.Patients with liver cirrhosis exhibited higher postprandial insulin and glucose concentrations compared to controls. Cirrhotics had higher fasting leptin that fell significantly postmeal and they showed an attenuated increase of ghrelin before the next expected meal. Altered glucose and hormonal levels in patients with cirrhosis were associated with poor food intake.Only a few patients with cirrhosis had increased intestinal permeability, as assessed by a 51 Cr-EDTA test, which was not influenced to a major extent by ascites. Conclusions: In patients with liver cirrhosis GI symptom severity is high and it is associated with impaired HRQOL and weight loss. Gastric accommodation is not involved in the poor food intake observed in cirrhotics and gastric sensitivity seems to be a relevant factor for GI symptom generation in these patients. Altered postprandial glucose, leptin, and ghrelin levels are correlated to reduced energy intake in this patient group. Increased intestinal permeability is probably of limited importance in the pathophysiology of bacterial infections in patients with liver cirrhosis and ascites.

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Section: Intestinal Permeability (Iv)mentioning

confidence: 91%

Section: Intestinal Permeabilitymentioning

confidence: 99%

Section: Intestinal Permeability (Iv)mentioning

confidence: 99%

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Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

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“…Intestinal absorption and permeability are often impaired in adult patients with liver disease. Patients with cirrhosis, in particular, have high prevalence (35-80%) of D-xylose and fat malabsorption [5][6][7], although some studies have shown no evidence of monosaccharide malabsorption [8,9]. Children with CLD frequently have evidence of malnutrition [10,11], which when severe may be an independent risk factor for adverse outcome of liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Brush border enzymes and absorptive capacity in extrahepatic portal venous obstruction in children

et al. 2010

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Background and objective Portal hypertension may affect intestinal functions, brush border enzymes and absorption parameters. Information about these in extrahepatic portal venous obstruction (EHPVO) in children is limited and poorly reported. We therefore studied the brush border enzymes and absorptive capacity in EHPVO in children. Methods The study was conducted on 52 children of EHPVO. The diagnosis of EHPVO was made on the basis of clinical presentation and ultrasound examination. All patients underwent upper gastrointestinal endoscopy. Endoscopic tissue biopsies from duodenum were taken on aluminum foils and kept immediately at -20°C for estimation of brush border enzymes. Tissue biopsies were homogenized in sodium maleate buffer, 0.1 M pH 6.0, by a homogenizer and processed for the enzymes: lactase, maltase, and sucrase. Enzyme levels were compared to normal healthy controls (n = 20). D-Xylose test, stool acid steatocrit for fat excretion in stools and stool alpha-1 antitrypsin were done to know about the absorptive parameters. Results Enzyme levels of lactase (6.21 ± 5.67 IU/mg) and sucrase (37.07 ± 21.06 IU/mg) in EHPVO group were significantly lower as compared to lactase (23.32 ± 10.48 IU/mg) and sucrase (95.96 ± 46.55 IU/mg) in normal healthy controls. Maltase levels were lower, but difference was not statistically significant in EHPVO group (56.90 ± 28.65 IU/mg) as compared to normal controls (63.28 ± 22.88 IU/mg). There was no significant difference of urinary D-xylose and stool fat in patients with normal or short stature EHPVO patients. Conclusion EHPVO leads to decrease in levels of brush border enzymes in small bowel but their absorption capacity remains normal.

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“…It has been shown that the gut, as a reservoir of enteric bacteria in the body, plays a protective role as mucosal barrier function, immunoglobulin secretion, and local and systemic macrophage system, but under liver cirrhosis (LC) with portal hypertension a correlative connection between liver damage and the functional activity of the intestine with mucosal abnor malities exist [1][2][3] . Increased intestinal permeability (IPI) with bacterial translocation and endotoxemia have been implicated www.wjgnet.com Lee S et al .…”

Section: Introductionmentioning

confidence: 99%

Increased intestinal macromolecular permeability and urine nitrite excretion associated with liver cirrhosis with ascites

Lee¹,

Son²,

Han³

et al. 2008

WJG

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AIM:To determine intestinal permeability, the serum tumor necrosis factor (TNF)-α level and urine nitric oxide (NO) metabolites are altered in liver cirrhosis (LC) with or without ascites. METHODS: Fifty-three patients with LC and 26 healthy control subjects were enrolled in the study. The intestinal permeability value is expressed as the percentage of polyethylene glycol (PEG) 400 and 3350 retrieval in 8-h urine samples as determined by high performance liquid chromatography. Serum TNF-α concentrations and urine NO metabolites were determined using an enzyme-linked immunosorbent assay (ELISA) and Greiss reaction method, respectively. RESULTS: The intestinal permeability index was significantly higher in patients with LC with ascites than in healthy control subjects or patients with LC without ascites (0.88 ± 0.12 vs 0.52 ± 0.05 or 0.53 ± 0.03, P < 0.05) and correlated with urine nitrite excretion (r = 0.98). Interestingly, the serum TNF-α concentration was significantly higher in LC without ascites than in control subjects or in LC with ascites (198.9 ± 55.8 pg/mL vs 40.9 ± 12.3 pg/mL or 32.1 ± 13.3 pg/mL, P < 0.05). Urine nitrite excretion was significantly higher in LC with ascites than in the control subjects or in LC without ascites (1170.9 ± 28.7 μmol/L vs 903.1 ± 55.1 μmol/L or 956.7 ± 47.7 μmol/L, P < 0.05). CONCLUSION:Increased intestinal macromolecular permeability and NO is probably of importance in the pathophysiology and progression of LC with ascites, but the serum TNF-α concentration was not related to LC with ascites.

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Investigation of intestine and liver function in cirrhosis using combined sugar oral loads

Cited by 36 publications

References 37 publications

Intestinal permeability in cirrhotic patients with and without ascites

Intestinal permeability in cirrhotic patients with and without ascites

Brush border enzymes and absorptive capacity in extrahepatic portal venous obstruction in children

Increased intestinal macromolecular permeability and urine nitrite excretion associated with liver cirrhosis with ascites

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