The Significance of Gut Permeability

Zusammenfassung

Die Darmpermeabilität wird klassischerweise definiert als das Ausmaß der Durchlässigkeit der Darmwand. In den letzten Jahren ist die erhöhte Durchlässigkeit für Bakterien oder Teile von Bakterien mit schweren Krankheitszuständen wie Multiorganversagen in Verbindung gebracht worden. Dieser Artikel gibt einen Überblick über die Bedeutung der „klassischen” Permeabilität für Krankheiten des Gastrointestinaltrakts und des Stoffwechsels und diskutiert die Bedeutung der „Darm-Leber-Achse”, d. h. die Erkrankung der Leber als Folge einer Darmkrankheit.

Abstract

Cut permeability is classically defined as the degree of diffusion across the gut wall. In recent years increased permeability for bacteria, or parts of bacteria has been associated with severe disease states like Multiple Organ Failure. This paper will review the relevance of “classical” permeability for gastroenterological and metabolic disease, and discuss the importance of the “gut-liver axis”, signifying liver disease secondary to intestinal disease.

References

• 1 Marshall J C, Christou N V, Meakins J L. The gastrointestinal tract. The “undrained abscess” of multiple organ failure.  Ann Surg. 1993;  218 (2) 11-119
• 2 Bjarnason I, MacPherson A, Hollander D. Intestinal permeability: an overview [see comments].  Gastroenterology. 1995;  108 (5) 1566-1581
• 3 Johnston S D, Smye M, Watson R P. Intestinal permeability tests in coeliac disease.  Clin Lab. 2001;  47 (3 - 4) 143-150
• 4 Travis S, Menzies I. Intestinal permeability: functional assessment and significance [editorial].  Clin Sci (Colch). 1992;  82 (5) 471-488
• 5 van der Hulst R R, van Kreel B K, von Meyenfeldt M F. et al . Glutamine and the preservation of gut integrity [see comments].  Lancet. 1993;  341 (8857) 1363-1365
• 6 Wyatt J, Vogelsang H, Hubl W, Waldhoer T, Lochs H. Intestinal permeability and the prediction of relapse in Crohn's disease.  Lancet. 1993;  341 (8858) 1437-1439
• 7 Jorgenson J RP. et al . Is an increased intestinal permeability a valid predictor of relapse in Crohn disease?.  Sand J Gastroenterol. 2001;  2 521-527
• 8 Harris C E, Griffiths R D, Freestone N, Billington D, Atherton S T, Macmillan R R. Intestinal permeability in the critically ill.  Intensive Care Med. 1992;  18 (1) 38-41
• 9 Lunn P G, Northrop-Clewes C A, Downes R M. Intestinal permeability, mucosal injury, and growth faltering in Gambian infants [see comments].  Lancet. 1991;  338 (8772) 907-910
• 10 Hande Dagci S U. et al . Protozoon infections and intestinal permeability.  Acta Tropica. 2002;  81 1-5
• 11 Rocha F, Laughlin R, Musch M W, Hendrickson B A, Chang E B, Alverdy J. Surgical stress shifts the intestinal Escherichia coli population to that of a more adherent phenotype: role in barrier regulation.  Surgery. 2001;  130 (1) 65-73
• 12 Sedman P C, Macfie J, Sagar P. et al . The prevalence of gut translocation in humans.  Gastroenterology. 1994;  107 (3) 643-649
• 13 Kanwar S, Windsor A C, Welsh F, Barclay G R, Guillou P J, Reynolds J V. Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery.  Ann Surg. 2000;  231 (1) 88-95
• 14 Rinsema W, Gouma D J, von Meyenfeldt M F, Soeters P B. Reinfusion of secretions from high-output proximal stomas or fistulas.  Surg Gynecol Obstet. 1988;  167 (5) 372-376
• 15 Alverdy J C, Chi H S, Selivanov V, Morris J, Sheldon G F. The effect of route of nutrient administration on the secretory immune system.  Curr Surg. 1985;  42 (1) 10-13
• 16 Spitz J C, Ghandi S, Taveras M, Aoys E, Alverdy J C. Characteristics of the intestinal epithelial barrier during dietary manipulation and glucocorticoid stress.  Crit Care Med. 1996;  24 (4) 635-641
• 17 Kiyama T, Witte M B, Thornton F J, Barbul A. The route of nutrition support affects the early phase of wound healing.  JPEN J Parenter Enteral Nutr. 1998;  22 (5) 276-279
• 18 Capron J P, Gineston J L, Herve M A, Braillon A. Metronidazole in prevention of cholestasis associated with total parenteral nutrition.  Lancet. 1983;  1 (8322) 446-447
• 19 Burke G W, Cirocco R, Hensley G. et al . Liver transplantation for cirrhosis following jejuno-ileal bypass - regional cytokine differences associated with pathological changes in the transplant liver.  Transplantation. 1992;  54 (2) 374-377
• 20 Lowell J A, Shenoy S, Ghalib R. et al . Liver transplantation after jejunoileal bypass for morbid obesity.  J Am Coll Surg. 1997;  185 (2) 123-127
• 21 Drenick E J, Fisler J, Johnson D. Hepatic steatosis after intestinal bypass - prevention and reversal by metronidazole, irrespective of protein-calorie malnutrition.  Gastroenterology. 1982;  82 (3) 535-548
• 22 Buttrose M, McKellar D, Welbourne T C. Gut-liver interaction in glutamine homeostasis: portal ammonia role in uptake and metabolism.  Am J Physiol. 1987;  252 (6 Pt 1) E746-750
• 23 Souba W W, Scott T E, Wilmore D W. Intestinal consumption of intravenously administered fuels.  JPEN J Parenter Enteral Nutr. 1985;  9 (1) 18-22
• 24 Phromphetcharat V, Jackson A, Dass P D, Welbourne T C. Ammonia partitioning between glutamine and urea: interorgan participation in metabolic acidosis.  Kidney Int. 1981;  20 (5) 598-605
• 25 Cynober L. Can arginine and ornithine support gut functions?.  Gut. 1994;  35 (1 Suppl) S42-45
• 26 Garcia-Lafuente A, Antolin M, Guarner F, Crespo E, Malagelada J R. Modulation of colonic barrier function by the composition of the commensal flora in the rat.  Gut. 2001;  48 (4) 503-507
• 27 Hofmann A F. The continuing importance of bile acids in liver and intestinal disease.  Arch Intern Med. 1999;  159 (22) 2647-2658
• 28 Radominska A TS, Little J. Bile Acid Metabolism and the Pathophysiology of Cholestasis.  Seminars in Liver Disease. 1993;  13 (3) 219-234
• 29 Welsh F K, Farmery S M, MacLennan K. et al . Gut barrier function in malnourished patients.  Gut. 1998;  42 (3) 396-401
• 30 Perdue M H. Mucosal immunity and inflammation. III. The mucosal antigen barrier: cross talk with mucosal cytokines.  Am J Physiol. 1999;  277 (1 Pt 1) G1-5
• 31 Bondar G F, Pisesky W. Complications of small intestinal short-circuiting for obesity.  Arch Surg. 1967;  94 (5) 707-716
• 32 Bailey M E. Endotoxin, bile salts and renal function in obstructive jaundice.  Br J Surg. 1976;  63 (10) 774-778
• 33 Cahill C J. Prevention of postoperative renal failure in patients with obstructive jaundice - the role of bile salts.  Br J Surg. 1983;  70 (10) 590-595
• 34 Cahill C J, Pain J A, Bailey M E. Bile salts, endotoxin and renal function in obstructive jaundice.  Surg Gynecol Obstet. 1987;  165 (6) 519-522
• 35 Roelofsen H, van der Veere C N, Ottenhoff R, Schoemaker B, Jansen P L, Oude E lferink. Decreased bilirubin transport in the perfused liver of endotoxemic rats.  Gastroenterology. 1994;  107 (4) 1075-1084
• 36 Dejong C H, Greve J W, Soeters P B. Nutrition in patients with acute pancreatitis.  Curr Opin Crit Care. 2001;  7 (4) 251-256
• 37 Carlo Welters C D, Deutz N, Heineman E. Intestinal adaptation in short bowel syndrome.  ANZJ Surg. 2002;  72 229-236
• 38 Welters C HE, Thunissen F. et al .Effect of dietary inulin supplementation on inflammation of pouch mucosa in patients with an ileal pouch-anal anastomosis. Dis Colon rectum 2002
• 39 Souba W W, Klimberg V S, Plumley D A. et al . The role of glutamine in maintaining a healthy gut and supporting the metabolic response to injury and infection.  J Surg Res. 1990;  48 (4) 383-391
• 40 Harris H W, Johnson J A, Wigmore S J. Endogenous lipoproteins impact the response to endotoxin in humans.  Crit Care Med. 2002;  30 (1) 23-31