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PWE-098 Increase in gut permeability is an early event in cirrhosis and is not associated with bacterial translocation, systemic inflammation or clinical features: a prospective longitudinal study
  1. F Figorilli1,
  2. J Macnaughtan1,
  3. A Moratalla2,
  4. RP Mookerjee1,
  5. N Davies1,
  6. R Jalan1
  1. 1Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
  2. 2Liver Unit, Hospital General Universitario de Alicante, CIBER de Enfermedades Hepáticas Y Digestivas (CIBERehd), Alicante, Spain, Alicante, Spain

Abstract

Introduction In cirrhosis, bacterial translocation (BT) is an early event and predicts occurrence of complications such as infection and mortality. In advanced liver failure, this is associated with increased gut permeability (GP) but the data in well-compensated cirrhosis is lacking. The aim of this study was to determine whether (a) GP is altered in patients with well-compensated cirrhosis (b) this was associated with bacterial translocation and (c) complications of cirrhosis.

Method Fifty-two stable cirrhotic patients (male: 33; age: 57, 1 ± 8, 36; Child A: 84, 6%, Child B: 15, 4%) were included and studied longitudinally at the time of inclusion and 1-month afterwards. Clinical and biochemical variables and complications were recorded. GP was measured using standard sugar probe-based assays. Bacterial DNA was measured in serum samples by PCR reaction for the 16S ribosomal RNA gene.

Results 19 patients (36, 5%) had an abnormal GP (>0,033). There are no differences in gender, age, aetiology; diabetes, WCC, MELD (9, 0 ± 2, 7 vs 9, 4 ± 3, 5) and complications of cirrhosis (infection: 18, 2% vs 10.5%, ascites: 54, 5% vs 31, 6%; HE 15, 2% 10, 5% and varices: 42, 4% vs 52, 6%). Only 2 patients showed evidence of BT. At 1-month, in patients with a GP <0,033, 69% showed an increase, 7 (24, 1%) a decrease and 2 were unchanged in the GP rate. In patients with abnormal GP, it worsened in 31, 3% and in 68, 7% it improved. The two patients that showed evidence of BT became negative after one month and both of them displayed an improvement of their GP. 3-patients became positive after 1-month, with two showing worsening of GP. Conversely, all of these changes were not associated with any complications of cirrhosis.

Conclusion The data of this prospective longitudinal study shows that alteration in GP occurs in a third of wellcompensated cirrhosis and is a dynamic abnormalities that improves or worsens with no apparent clinical sequaela. Increased GP is not associated with evidence of bacterial translocation, clinical characteristics or systemic inflammation in well-compensated cirrhosis. It is likely that increased gut permeability is an early event but bacterial translocation in humans occurs late and factors other than translocated bacteria such as its products or metabolites contribute to clinical manifestations.

Disclosure of interest None Declared.

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