Lactulose-L-rhamnose intestinal permeability test in patients with liver cirrhosis

Fujii, Toshihito; Seki, Toshihito; Maruoka, Masanori; Tanaka, Jun; Y, Kawashima; Watanabe, Toshihiko; Sawamura, Takaya; Inoue, Katsumi

doi:10.1016/s1386-6346(00)00099-1

Cited by 30 publications

(22 citation statements)

References 14 publications

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“…9 Another study also reported higher intestinal permeability in 35 patients with cirrhosis as compared to 6 healthy volunteers using urinary lactulose/rhammnose excretion ratio. 17 The results of the present study on patients with cirrhosis are in accordance with the earlier studies.…”

Section: Discussionsupporting

confidence: 93%

“…14 In contrast, patients with cirrhosis had abnormal SIP. 9,17 In an earlier study, it was found that the urinary lactulose/mannitol excretion ratio was higher in 80 patients with cirrhosis than in 28 controls. 9 Another study also reported higher intestinal permeability in 35 patients with cirrhosis as compared to 6 healthy volunteers using urinary lactulose/rhammnose excretion ratio.…”

Section: Discussionmentioning

confidence: 95%

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Frequency and factors associated with increased small intestinal permeability in patients with portal hypertension

Goyal¹

2013

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Aim: Cirrhosis with portal hypertension (PHT) may be associated with increased small intestinal permeability (SIP), predisposing to malnutrition and bacterial translocation causing septicaemia, endotoxaemia and spontaneous bacterial peritonitis. However, data on SIP in extrahepatic portal venous obstruction (EHPVO), in which PHT occurs without hepatic dysfunction, are scanty. Such studies would help to know the effect of PHT on SIP independent of hepatic dysfunction; hence, we undertook this study.Methods: A total of 96 patients with PHT (cirrhosis 71, EHPVO 25) underwent evaluation of SIP using urinary lactulose/mannitol excretion ratio over 6 hours after oral administration of 15 mL (10 g) lactulose and 5 g mannitol using 1H-NMR spectroscopy by a method described by us previously.Results: Gender of patients with EHPVO and cirrhosis was comparable but patients with EHPVO were younger in age. The causes of cirrhosis were cryptogenic (n=22), alcohol (n=20), post-viral (n=21) and others (n=8). Twenty-seven (38%) patients with cirrhosis had ascites. Abnormal SIP was detected in 47 (49%) patients (40/71, 56% with cirrhosis vs. 7/25, 28% with EHPVO, p=0.01). Patients with cirrhosis had a higher urinary lactulose/mannitol excretion ratio than those with EHPVO (0.09, range 0-0.87 mmol vs. 0.05, 0-0.19 mmol; p=0.008). Patients with abnormal SIP had a higher Child score, and more often had cirrhosis than EHPVO, ascites and deranged liver function. On multivariate analysis, presence of cirrhosis, ascites, high serum bilirubin level and prothrombin time were associated with abnormal SIP. Conclusions: Cirrhosis was associated with abnormal SIP, which was related to liver dysfunction. However, SIP was normal in patients with EHPVO.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 95%

Frequency and factors associated with increased small intestinal permeability in patients with portal hypertension

Goyal¹

2013

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“…A minimal sample size of 34 individuals per group was calculated assuming an alpha level of 0.05 and a beta level of 0.80 for the detection of a mean difference in the L/R ratio of 0.02, based on a study by Fujii et al that reported a mean (SD) L/R ratio of 0.049 (0.008) [9].…”

Section: Discussionmentioning

confidence: 99%

The influence of epidural blockade on gut permeability in patients undergoing open surgical repair of abdominal aortic aneurysm

Owczuk

Dylczyk-Sommer

Wojciechowski

et al. 2016

Anaesthesiol Intensive Ther

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Background: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes. Methods: Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio. Results: No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G. Conclusions:Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.

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“…However, other investigators have suggested that intestinal permeability is probably of limited importance in the pathophysiology of bacterial infections in patients with LC [5] . Intestinal permeability in LC has been reported as being increased or normal [6][7][8][9][10] . The development of systemic endotoxemia may in turn act through the release of cytokines, to further increase intestinal permeability, impair host immunity and promote bacterial translocation from the gut, thus resulting in a vicious circle [11,12] .…”

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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Lactulose-L-rhamnose intestinal permeability test in patients with liver cirrhosis

Cited by 30 publications

References 14 publications

Frequency and factors associated with increased small intestinal permeability in patients with portal hypertension

Frequency and factors associated with increased small intestinal permeability in patients with portal hypertension

The influence of epidural blockade on gut permeability in patients undergoing open surgical repair of abdominal aortic aneurysm

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

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