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Endotoxins in portal blood
S J van Deventer1, A Knepper, J Landsman
1Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Hepato-Gastroenterology
|October 1, 1988
Summary
The healthy bowel lining effectively prevents endotoxins from entering the bloodstream. Portal endotoxemia in liver disease likely stems from increased bowel wall permeability, not continuous endotoxin transmigration.
Area of Science:
- Gastroenterology
- Hepatology
- Critical Care Medicine
Background:
- Endotoxemia, often linked to bowel and liver diseases, can cause severe complications like renal failure and coagulation disorders.
- The bowel is a significant reservoir of endotoxins, with classical theories suggesting constant transmigration into portal circulation.
- Previous research on portal endotoxemia has yielded conflicting results.
Purpose of the Study:
- To investigate the presence and levels of endotoxins in the portal vein of individuals without liver or bowel disease.
- To evaluate the integrity of the bowel mucosa as a barrier against endotoxin translocation.
Main Methods:
- Utilized a sensitive chromogenic endotoxin assay to detect endotoxins.
- Analyzed portal vein blood samples from 21 consecutive patients without pre-existing liver or bowel conditions.
- Assessed endotoxin levels specifically after aortic cross-clamping and reperfusion.
Main Results:
- Low-level portal endotoxemia was detected in only two out of 21 patients.
- Endotoxemia was observed only following aortic cross-clamping and reperfusion, suggesting transient events.
- The normal bowel mucosa demonstrated effective barrier function against endotoxin passage.
Conclusions:
- The normal bowel mucosa acts as a robust barrier against endotoxin translocation.
- Intestinal endotoxemia complicating liver disease is more likely attributed to compromised bowel mucosal integrity (increased permeability).
- Findings challenge the classical hypothesis of continuous endotoxin transmigration in healthy individuals.