No evidence for increased intestinal permeability in cirrhosis

Background:

Alterations in intestinal permeability in patients with liver cirrhosis (LC) have been implicated as an important factor for bacterial translocation (BT), leading to various complications, like spontaneous bacterial peritonitis (SBP).

Aim:

To evaluate the intestinal permeability to macromolecules in patients with liver cirrhosis as compared to healthy controls and determine their significance in relation with the disease severity (MELD Score).

Methods:

Polyethylene glycol has been used to measure intestinal permeability. The permeability to polyethylene glycol Mr 400 and Mr 1000 were measured in 10 patients with liver cirrhosis of different etiology and in 10 healthy controls. Three of the patients with liver cirrhosis already experienced a SBP.

Results:

No statistically significant difference was found in the permeability to polyethylene glycol Mr 400 in patients with liver cirrhosis in comparison to healthy controls, whereas polyethylene glycol Mr 1000 was recovered in more then twice as low concentrations in the urine of cirrhotic patients (Mean 5.3135/13.6041, p-value 0.03). The increase of the MELD Score in the patients with LC showed a decreased relative recovery of PEG, but the correlation was statistically not significant. No significant difference was found comparing the patients with liver cirrhosis who already experienced a SBP and those who did not.

Conclusion:

Patients with liver cirrhosis showed no increase of the intestinal permeability as measured by polyethylene glycol. Bacterial translocation may be favoured by motility disfunction and bacterial overload rather than by alterations in intestinal permeability.