GUT 1998;42:396-401 ( March )

Gut barrier function in malnourished patients

F K S Welsh,^a S M Farmery,^a K MacLennan,^a M B Sheridan,^a G R Barclay,^b P J Guillou,^a J V Reynolds^a

^a Academic Surgical Unit, Department of Pathology, St James's University Hospital, Leeds, United Kingdom, ^b Regional Blood Transfusion Centre, Edinburgh, United Kingdom

Correspondence to: Mr John V Reynolds, Academic Surgical Unit, Level 8, Clinical Sciences Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom.

Accepted for publication 23 September 1997

BackgroundThe integrity of the gastrointestinal mucosa is a key element in preventing systemic absorption of enteric toxins and bacteria. In the critically ill, breakdown of gut barrier function may fuel sepsis. Malnourished patients have an increased risk of postoperative sepsis; however, the effects of malnutrition on intestinal barrier function in man are unknown.
AimsTo quantify intestinal barrier function, endotoxin exposure, and the acute phase cytokine response in malnourished patients.
PatientsMalnourished and well nourished hospitalised patients.
MethodsGastrointestinal permeability was measured in malnourished patients and well nourished controls using the lactulose:mannitol test. Endoscopic biopsy specimens were stained and morphological and immunohistochemical features graded. The polymerase chain reaction was used to determine mucosal cytokine expression. The immunoglobulin G antibody response to endotoxin and serum interleukin 6 were measured by enzyme linked immunosorbent assay.
ResultsThere was a significant increase in intestinal permeability in the malnourished patients in association with phenotypic and molecular evidence of activation of lamina propria mononuclear cells and enterocytes, and a heightened acute phase response.
ConclusionsIntestinal barrier function is significantly compromised in malnourished patients, but the clinical significance is unclear.
(GUT 1998;42:396-401)

Keywords: protein-energy malnutrition;  intestinal permeability;  endotoxin;  cytokine

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© 1998 by Gut
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