A Study of Intestinal Permeability in Relation to the... : Journal of Clinical Gastroenterology (original) (raw)

Liver, Pancreas, and Biliary Tract: Clinical Research

A Study of Intestinal Permeability in Relation to the Inflammatory Response and Plasma Endocab IgM Levels in Patients with Acute Pancreatitis

Penalva, Juan C MD†; Martínez, Juan MD, PHD*; Laveda, Raquel MD*; Esteban, Angel PHD§; Muñoz, Carlos MD, PHD†; Sáez, Jesús MD, PHD*; Such, José MD, PHD*; Navarro, Salvador MD, PHD¶; Feu, Faust MD, PHD¶; Sánchez-Payá, José MD, PHD‡; Pérez-Mateo, M MD, PHD*

From the *Department of Internal Medicine, †Department of Immunology, ‡Department of Epidemiology, and §Research Unit, Hospital General Universitario Alicante, Hospital General Elche, Alicante, Spain; ¶Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clinic i Provincial, IDIBAPS, Barcelona, Spain.

Received for publication June 11, 2003;

accepted March 2, 2004.

This work was supported in part by grants from Sociedad Espanola de Patologia Digestiva & Instituto de Salud Carlos III (CO3/02)

Reprints: Dr. Miguel Pérez-Mateo, Servicio Aparato Digestivo, 4aC, Hospital General, Universitario Alicante, Universidad Miguel Hernández, C/ Pintor Baeza s/n, CP- 03010, Alicante. Spain (e-mail: perezmateo [email protected]).

Abstract

Background:

There is scarce information regarding intestinal permeability (IP) in patients with acute pancreatitis (AP) and its relationship with systemic inflammatory response and bacterial translocation (BT).

Aims:

To study IP in patients with mild and severe forms of AP as compared with controls and the presumed correlations between IP, the inflammatory response, and endotoxin.

Patients and methods:

Sixty-eight patients with AP and 13 healthy controls were included. IP was assessed by means of the lactulose/mannitol (L/M) test, at admission (LMR1), and at the 15th day (LMR2). The presence of endotoxin was assessed by means of endotoxin-core antibodies type IgM (EndoCab IgM), at admission and 15 days later in patients with severe AP. Plasma levels of interleukins 6, 8, 10, and tumor necrosis factor α were tested within the first 72 hours from the onset of pain.

Results:

Both LMR1 and LMR2 were significantly higher in patients than in controls, and in patients with severe versus mild forms of AP. Plasma levels of Endocab IgM increased significantly in patients with severe AP. Basal plasma levels of pro- and anti-inflammatory cytokines were significantly higher in patients with severe AP. A significant correlation was found between LMR2 and Endocab IgM levels in patients with severe AP (r = 0.73, P = 0.02).

Conclusions:

Patients with AP show an increased IP when compared with controls, being more relevant and persistent in severe cases. This seems related to an increase of endotoxemia late in the course of the disease, but not with an exacerbation of the systemic immune response.