Prevention of postoperative renal failure in patients with obstructive jaundice—the role of bile salts

Cahill, C. J.

doi:10.1002/bjs.1800701008

Cited by 125 publications

(52 citation statements)

References 25 publications

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“…In the present study, expression of markers of ER stress were generally lower in mice treated with bile acids; however, fructose feeding seemed not to have been associated with an enhancement of ER stress in the duodenum of mice compared to water controls. It also has been suggested by the results of other groups that bile acids may inhibit bacterial growth in the intestine ( 26,48,49 ). However, in the present study, the protective effects found in fructose-fed mice concomitantly treated with bile acids were not associated with changes in number of bacteria in the duodenum.…”

Section: Discussioncontrasting

confidence: 68%

Protective effect of bile acids on the onset of fructose-induced hepatic steatosis in mice

Volynets

Spruss

Kanuri

et al. 2010

Journal of Lipid Research

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This article is available online at http://www.jlr.org phase of NAFLD ( 2 ). Furthermore, results of recent studies suggest that steatosis may play a critical role not only in the onset of NAFLD but also in its progression to later stages of the disease (e.g., fi brosis and cirrhosis ( 3 )). Therefore, therapies protecting against the onset of NAFLD may also be benefi cial for the later stages of the disease.Results of several epidemiologic and clinical studies indicate that besides a general over-nutrition dietary intake of carbohydrates and fructose consumption in particular may play a critical role in the development of NAFLD in humans ( 4 ). The hypothesis that a diet rich in mono-and disaccharides, such as fructose and sucrose, might play a critical role in the pathogenesis of NAFLD is also supported by a number of studies performed in animals. In these studies, it was shown that an increased consumption of fructose (e.g., up to 60% of daily calories derived from fructose) resulted in an increased lipid accumulation in the liver, which was accompanied by insulin resistance, elevated plasma triglyceride levels, and oxidative stress ( 5-9 ). Recently, our group was able to show that hepatic steatosis resulting from chronic intake of fructose is associated with a loss of the tight junction protein occludin in the duodenum, an increased translocation of bacterial endotoxins from the intestine, and an induction of tumor necrosis factor (TNF) ␣ in the liver of mice ( 7, 10, 11 ). However, while plasma levels of TNF ␣ and retinol binding protein 4 were both increased under this feeding regimen, suggesting that fructose-fed mice were insulin-resistant, glucose levels in blood of food-deprived, fructose-fed mice did not differ from those of water-fed controls ( 7, 10 ). In these studies, the concomitant treatment with antibiotics Abstract Fructose intake is being discussed as a key dietary factor in the development of nonalcoholic fatty liver disease (NAFLD). Bile acids have been shown to modulate energy metabolism. We tested the effects of bile acids on fructoseinduced hepatic steatosis. In C57BL/6J mice treated with a combination of chenodeoxycholic acid and cholic acid (100 mg/kg body weight each) while drinking water or a 30% fructose solution for eight weeks and appropriate controls, markers of hepatic steatosis, portal endotoxin levels, and markers of hepatic lipogenesis were determined. In mice concomitantly treated with bile acids, the onset of fructoseinduced hepatic steatosis was markedly attenuated compared to mice only fed fructose. The protective effects of the bile acid treatment were associated with a downregulation of tumor necrosis factor (TNF) ␣ , sterol regulatory element-binding protein (SREBP)1, FAS mRNA expression, and lipid peroxidation in the liver, whereas hepatic farnesoid X receptor (FXR) or short heterodimer partner (SHP) protein concentration did not differ between groups fed fructose. Rather, bile acid treatment normalized occludin protein concentration in the duodenum, portal endotoxin...

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Section: Discussioncontrasting

confidence: 68%

Protective effect of bile acids on the onset of fructose-induced hepatic steatosis in mice

Volynets

Spruss

Kanuri

et al. 2010

Journal of Lipid Research

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“…First, three studies used external biliary drainage only, 26,32,35 six studies reported on the use of only internal biliary drainage, 27,30,33,34,37,40 and most studies used both. 11,14 -16,22-25,28,29,31,36,38,39 Although both decompress the biliary tract, the pathophysiologic consequence of internal drainage is entirely different from that of external drainage in terms of restoration of the enterohepatic cycle, 43,44 colonization of the biliary tract, 12,45 and inflammatory reaction of the biliary tract. 13 Second, different levels of biliary obstruction are compared as one.…”

Section: Discussionmentioning

confidence: 99%

A Meta-analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice

Sewnath¹,

Karsten²,

Prins³

et al. 2002

Annals of Surgery

389

223

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ObjectiveTo review the effectiveness of preoperative biliary drainage (PBD) in patients with obstructive jaundice resulting from tumors. Summary Background DataThis was a systematic review, including a meta-analysis, of randomized controlled trials and comparative cohort studies conducted worldwide and published between 1966 and September 2001, classified on methodologic strength and subdivided into level 1 (randomized controlled trials) and level 2 (comparative cohort studies). MethodsComparison was made of PBD versus no PBD in jaundiced patients undergoing resection of a tumor. Outcome measures were in-hospital death rate, overall complications resulting from the treatment modality (drainage-and surgery-related complications), and hospital stay. Effect sizes were calculated and combined in meta-analyses. Relative differences (%) were calculated to compare effects on outcome measures. ResultsFive randomized controlled studies comprising 302 patients met the inclusion criteria for level 1 studies, and 18 cohort studies comprising 2,853 patients met the criteria for level 2 studies. Meta-analysis of level 1 studies showed no difference in the overall death rate between patients who had PBD and those who had surgery without PBD. The overall complication rate, however, was significantly adversely affected by PBD compared with surgery without PBD. At level 2, there was no difference in the death rate between the two treatment modalities. The overall complication rate, however, was significantly adversely affected by PBD compared with surgery without PBD. If PBD had been without complications, then complications would be in favor of drainage based on level 1 studies, and no difference based on level 2 studies. Further, PBD was not able to reduce the length of postoperative hospital stay compared with surgery without PBD; instead, it prolonged the stay. ConclusionsThis meta-analysis shows that PBD with current standards for patients with obstructive jaundice resulting from tumors carries no benefit and should not be performed routinely. The potential benefit of PBD in terms of postoperative rates of death and complications does not outweigh the disadvantage of the drainage procedure. Only if PBD-related complications could be reduced by 27% and consequently diminish hospital stay could PBD be beneficial. Further randomized controlled trials with improved PBD techniques are necessary.

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“…Among these adverse effects are suppression of cellular immunity [26], hemodynamic disturbances [27], induction of intravascular coagulation [28], and metabolic derangements [29]. There is plenty of clinical and experimental evidence showing the presence of systemic endotoxemia in obstructive jaundice and endotoxin, and through its direct or indirect harmful effects, it has been implicated in the pathophysiology of obstructive jaundice [30, 31]. In addition to bacterial overgrowth promoted by the absence of intraluminal bile, altered intestinal barrier function is also thought to be responsible for the increased translocation of bacteria and their toxins from the lumen to normally sterile extraintestinal sites including liver, mesenteric lymph node complex, spleen, and blood [32].…”

Section: Discussionmentioning

confidence: 99%

Obstructive Jaundice Alters CD44 Expression in Rat Small Intestine

Sheen-Chen

Chen

et al. 2002

Digestion

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Hypothesis: CD44 is an adhesion molecule expressed by neutrophils, lymphocytes and epithelial cells. CD44 is involved in cell-cell and cell-matrix binding. In addition to lymphocyte trafficking, CD44 also plays a crucial role in the maintenance of intestinal villus integrity. We hypothesize that obstructive jaundice may alter CD44 expression in the rat small intestine and oral glutamine intake can restore the altered CD44 expression in the small intestine of the rat undergoing obstructive jaundice. Materials and Methods: In a prospective animal model study at a university hospital, 41 Sprague-Dawley rats were randomized to 4 groups. Group A (n = 13, control) underwent a sham operation. Group B (n = 12, obstructive jaundice for 1 week) underwent common bile duct ligation. Group C (n = 8, obstructive jaundice for 2 weeks) underwent common bile duct ligation. Group D (n = 8, obstructive jaundice for 2 weeks) underwent common bile duct ligation with oral glutamine intake daily. After 1 and 2 weeks, segments of the proximal jejunum and distal ileum were harvested from groups A and B and groups C and D, respectively. Immunohistochemical expression of CD44 on the cell surface was then evaluated and recorded. Comparisons among the 4 groups were performed. Results: In the 1-week obstructive jaundice group, 173.8 ± 24.0 cells/1,000 enterocytes of the proximal jejunum expressed surface CD44, while 137.0 ± 13.8 cells were stained in the control group (p < 0.001). In the 1-week obstructive jaundice group, 169.8 ± 20.7 cells/1,000 enterocytes of the distal ileum expressed surface CD44, while 119.5 ± 20.8 cells were stained in the control group (p < 0.001). In the 2-week obstructive jaundice group, the number of cells expressing surface CD44 were significantly decreased both in jejunum (112.1 ± 17.0, p = 0.002) and ileum (100.1 ± 12.5, p = 0.028) when compared with those of the control group. With daily oral glutamine intake in group D, the number of cells expressing surface CD44 in the jejunum (149.3 ± 29.7) was restored to that of the control group (p = 0.302) and the number of cells expressing surface CD44 in the ileum (140.4 ± 23.0) was even higher than that of the control group (p = 0.045). Conclusion: Obstructive jaundice for 1 week initially upgraded CD44 expression in the rat small intestine and the CD44 expression later became significantly depressed after obstructive jaundice for 2 weeks. Oral glutamine intake daily could effectively restore the CD44 expression in the small intestine of the rat undergoing obstructive jaundice for 2 weeks.

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Prevention of postoperative renal failure in patients with obstructive jaundice—the role of bile salts

Cited by 125 publications

References 25 publications

Protective effect of bile acids on the onset of fructose-induced hepatic steatosis in mice

Protective effect of bile acids on the onset of fructose-induced hepatic steatosis in mice

A Meta-analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice

Obstructive Jaundice Alters CD44 Expression in Rat Small Intestine

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