Non-selective betablocker therapy decreases intestinal permeability and serum levels of LBP and IL-6 in patients with cirrhosis

Background & Aims We evaluated the gastrointestinal permeability and bacterial translocation in cirrhotic patients with portal hypertension (PHT) prior to and after non-selective betablocker (NSBB) treatment. Methods Hepatic venous pressure gradient (HVPG) was measured prior to and under NSBB treatment. Gastroduodenal and intestinal permeability was assessed by the sucrose–lactulose–mannitol (SLM) test. Anti-gliadin and anti-endomysial antibodies were measured. Levels of LPS-binding protein (LBP) and interleukin-6 (IL-6) were quantified by ELISA, and NOD2 and toll-like receptor 2 ( TLR2 ) polymorphisms were genotyped. Results Fifty cirrhotics were included (72% male, 18% ascites, 60% alcoholic etiology). Abnormal gastroduodenal and intestinal permeability was found in 72% and 59% of patients, respectively. Patients with severe portal hypertension (HVPG ⩾20 mmHg; n = 35) had increased markers of gastroduodenal/intestinal permeability (urine sucrose levels p = 0.049; sucrose/mannitol ratios p = 0.007; intestinal permeability indices p = 0.002), and bacterial translocation (LBP p = 0.002; IL-6 p = 0.025) than patients with HVPG