Intestinal barrier dysfunction in liver cirrhosis assessed by iohexol test

V.A. Gerova, D.A. Svinarov, R.V. Nakov, S.G. Stoynov, L.T. Tankova, V.N. Nakov

Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital – Medical University of Sofia, Sofia, Bulgaria. radislav.nakov@gmail.com

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• Gastroenterology

OBJECTIVE: To study gut barrier function in patients with liver cirrhosis (LC) by evaluating the intestinal permeability (IP) and its relationship with the severity and etiology of the disease.

PATIENTS AND METHODS: The study included 31 patients with LC and 25 healthy controls. Child-Pugh score was used for evaluation of the LC severity. IP was assessed by the rise in levels of iohexol, which was administered orally (25 mL, 350 mg/mL) 2 h after breakfast. Three and six hours later serum (SIC mg/L) and urine (UIC g/mol) iohexol concentrations were determined by a validated HPLC-UV technique.

RESULTS: Patients with LC had significantly higher mean SIC value compared with control group at 3 h (2.05 ± 1.67 vs. 1.25 ± 1.41 mg/L, p=0.021, as well as at 6 h (2.20 ± 2.65 vs. 1.11 ± 1.06 mg/L, p=0.001) after ingestion. No significant difference was found in mean SIC value of patients at 3 and 6 h. 23% of the patients had an increased IP. The mean iohexol urine recovery of patients was similar to that of the controls both at 3 h and at 6 h. Mean SIC values were significantly higher in patients with advanced Child C class than in healthy controls or the subgroup with Child B class, both at 3 h (2.54 ± 1.95 mg/L vs. 1.11 ± 1.06 mg/L, p=0.007) or (2.57 ± 1.85 mg/L vs. 1.35±1.32 mg/L, p=0.005) and at 6 h (2.57 ± 1.85 mg/L vs. 1.25 ± 1.40 mg/L, p=0.002) or 2.54 ± 1.95 mg/L vs. 1.07 ± 0.35 mg/L, p=0.02). Cirrhotic patients with ascites had significantly higher SIC in comparison with the controls, both at 3 h (2.31 ± 1.74 vs. 1.25 ± 1.41 mg/, p=0.009) and at 6 h (2.20 ± 1.87 vs. 1.11 ± 1.06 mg/l, p=0.007). In the subgroup of patients with alcoholic LC, the mean SIC values at 3 and 6 h (2.29 ± 1.80, 2.33 ± 1.85 mg/L, respectively) were significantly higher (p= 0.016, p=0.003) compared to the control group (1.25 ± 1.41, 1.11 ± 1.06 mg/L, respectively).

CONCLUSIONS: Increased IP is found in 23% of cirrhotic patients. Permeability alterations are significantly more pronounced in patients with advanced LC with the presence of ascites and in those with alcoholic etiology.

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