Increased intestinal permeability associated with infection in burn patients
T. R. Ziegler, R. J. Smith, S. T. O'Dwyer, R. H. Demling and D. W. Wilmore
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02215.
Thermal injury may be associated with disruption of normal gut barrier
integrity. To test this hypothesis, we assessed intestinal permeability
with the nonmetabolizable, poorly absorbed disaccharide lactulose, which is
efficiently excluded by the normal intestinal mucosa. Permeability studies
were performed in 15 burned patients (aged 18 to 67 years; mean burn size,
40%) and 11 healthy controls. Lactulose, 10 g, was administered enterally,
together with 5 g of mannitol as a control, and urinary excretion rates
were determined. Lactulose excretion and the lactulose/mannitol excretion
ratio increased threefold (160 +/- 30 vs 57 +/- 7 mumol and 0.113 +/- 0.033
vs 0.035 +/- 0.005) in the infected patients (sepsis score, 10 +/- 2; burn
size, 38% +/- 6%). In contrast, noninfected burn patients (sepsis score, 0)
had permeability values similar to those of controls (66 +/- 10 mumol and
0.036 +/- 0.007). Permeability increased as the severity of infection
increased. Infection in burn patients is associated with increased bowel
permeability. The intestine may be a primary source of sepsis.
Alternatively, the systemic response to infection may alter gut barrier
function, which could facilitate translocation of bacteria and absorption
of endotoxin.
Jonathan E. Rhoads Lecture: Of Mice and Men... and a Few Hundred Rats
Kudsk
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Ziegler et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2008;294:R402-R410.
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The Effect of Glutamine-Enriched Enteral Nutrition on Intestinal Permeability in Very-Low-Birth-Weight Infants: A Randomized Controlled Trial
van den Berg et al.
JPEN J Parenter Enteral Nutr 2006;30:408-414.
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Insulin-like growth factor I improves intestinal barrier function in cirrhotic rats
Lorenzo-Zuniga et al.
Gut 2006;55:1306-1312.
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The contribution of radiation-induced injury to the gastrointestinal tract in the development of multi-organ dysfunction syndrome or failure
Monti et al.
Br. J. Radiol. 2005;Supplement_27:89-94.
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Selective decontamination of the digestive tract attenuated the myocardial inflammation and dysfunction that occur with burn injury
Horton et al.
Am. J. Physiol. Heart Circ. Physiol. 2004;287:H2241-H2251.
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Neutrophil depletion prevents intestinal mucosal permeability alterations in burn-injured rats
Sir et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2000;278:R1224-R1231.
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Increased lactulose/rhamnose ratio during fluid load is caused by increased urinary lactulose excretion
Hallemeesch et al.
Am. J. Physiol. Gastrointest. Liver Physiol. 2000;278:G83-G88.
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Acquired interferon gamma responsiveness during Caco-2 cell differentiation: effects on iNOS gene expression
Chavez et al.
Gut 1999;44:659-665.
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Reticuloendothelial System Activity and Organ Failure in Patients With Multiple Injuries
Pape et al.
Arch Surg 1999;134:421-427.
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Increased Intestinal Permeability Is Associated with the Development of Multiple Organ Dysfunction Syndrome in Critically Ill ICU Patients
DOIG et al.
Am. J. Respir. Crit. Care Med. 1998;158:444-451.
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Gut barrier function in malnourished patients
Welsh et al.
Gut 1998;42:396-401.
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Differential effects of an infusion of endotoxin on proximal and distal feline jejunal permeability
Jackman et al.
Innate Immunity 1996;3:77-86.
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