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Intestinal permeability increases with the severity of abdominal trauma: a comparison between gas liquid
E Liverani1, N G Silveri, G Gasbarrini
1Department of Internal Medicine, Catholic University, Rome, Italy.
Background/Aims:
Increased intestinal permeability was found in humans after multiple trauma, burn injury and major vascular surgery. However, no data are reported regarding possible correlation between trauma and intestinal permeability degree. This study was undertaken to compare gas-liquid chromatographic and enzymatic method for the evaluation of intestinal permeability impairment in patients after severe abdominal trauma.
Methodology:
Five traumatized patients with an injury severity score of more than 24 and 5 cross-matched healthy volunteers were studied. The intestinal permeability was performed using a test solution, containing 10 g lactulose and 5 g mannitol. Gas-liquid chromatographic method was applied to measure sugar standards and 5-hour urine samples and the results were compared with those obtained employing a specific enzymatic method.
Results:
Linearity of myoinositol, lactulose and mannitol measured by gas-liquid chromatographic method was from 0.2-1 microgram injected. Using the enzymatic method, the response was linear between mannitol concentrations of 0.34 and 5.49 mM. Linearity of lactulose standard was from 0.18-2.92 mM. The gas-liquid chromatographic and enzymatic methods showed a good agreement using the Bland-Altman procedure. The mean lactulose/mannitol ratio was 0.085 +/- 0.025 in patients and 0.009 +/- 0.001 in controls (P < 0.001). The higher the injury severity score (30.8 +/- 5) the larger the ratio of lactulose to mannitol (R2 = 0.74).
Conclusions:
The enzymatic method--inexpensive, easy-to-perform and timesaving--is suitable for intestinal permeability studies. An abdominal trauma, without injury requiring surgical operation, modifies the intestinal mucosa permeability possibly favoring passage of bacteria and subsequent sepsis.