Intestinal permeability in liver cirrhosis

Objective To determine the changes in intestinal permeability in liver cirrhosis and to investigate whether intestinal permeability relates to the stage and aetiology of cirrhosis or existence of spontaneous bacterial peritonitis (SBP). Design A prospective study of intestinal permeability in patients with cirrhosis. Setting Gastroenterology and Nuclear Medicine Departments of Ege University Hospital. Participants Intestinal permeability was assessed in 44 consecutive patients with cirrhosis and 10 healthy volunteers by measuring 24 h urine excretion of technetium diethyl triamine penta-acetic acid (Tc DTPA). Cases with an associated disease, impaired renal function, continuing alcohol consumption and drug intake which is known to have an effect on intestinal permeability were excluded. Main outcome measures Comparisons of 24 h urine excretion of Tc DTPA were made between the groups of cirrhotics and controls, different grades of cirrhosis (according to Child-Pugh criteria), alcoholic and nonalcoholic cirrhotics and cirrhotic patients with and without SBP. Results Patients with cirrhosis excreted Tc DTPA significantly more than controls (11.56 ± 8.96% in cirrhotics and 4.30 ± 1.49% in controls, P < 0.0001). There was no relationship of 24 h urine excretion of the tracer with the grade and aetiology of cirrhosis (12.20 ± 9.47%, 11.41 ± 9.84%, and 11.09 ± 8.42%, in Child A, B, and C groups and 8.45 ± 6.57% and 12.05 ± 9.25% in alcoholic and non-alcoholic cirrhotics, respectively). No significant difference was found between cirrhotic patients with and without SBP in terms of excretion of the administered dose of Tc DTPA (9.98 ± 9.47% and 12.20 ± 8.82%, respectively). Conclusions This study shows that intestinal permeability increased in cirrhotic patients regardless of the grade and aetiology of disease. The presence of SBP does not seem to be due to increased intestinal permeability. Eur J Gastroenterol Hepatol 11:409–412 1999 Lippincott Williams & Wilkins