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. 1998 Mar;42(3):396–401. doi: 10.1136/gut.42.3.396

Gut barrier function in malnourished patients

F Welsh 1, S Farmery 1, K MacLennan 1, M Sheridan 1, G Barclay 1, P Guillou 1, J Reynolds 1
PMCID: PMC1727047  PMID: 9577348

Abstract

Background—The integrity of the gastrointestinal mucosa is a key element in preventing systemic absorption of enteric toxins and bacteria. In the critically ill, breakdown of gut barrier function may fuel sepsis. Malnourished patients have an increased risk of postoperative sepsis; however, the effects of malnutrition on intestinal barrier function in man are unknown. 
Aims—To quantify intestinal barrier function, endotoxin exposure, and the acute phase cytokine response in malnourished patients. 
Patients—Malnourished and well nourished hospitalised patients. 
Methods—Gastrointestinal permeability was measured in malnourished patients and well nourished controls using the lactulose:mannitol test. Endoscopic biopsy specimens were stained and morphological and immunohistochemical features graded. The polymerase chain reaction was used to determine mucosal cytokine expression. The immunoglobulin G antibody response to endotoxin and serum interleukin 6 were measured by enzyme linked immunosorbent assay. 
Results—There was a significant increase in intestinal permeability in the malnourished patients in association with phenotypic and molecular evidence of activation of lamina propria mononuclear cells and enterocytes, and a heightened acute phase response. 
Conclusions—Intestinal barrier function is significantly compromised in malnourished patients, but the clinical significance is unclear. 



Keywords: protein-energy malnutrition; intestinal permeability; endotoxin; cytokine

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Figure 1 .

Figure 1

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Intestinal permeability in control, mild/moderately malnourished, and severely malnourished patients. Intestinal permeability is represented on the y axis by the urinary lactulose:mannitol ratio (L:M ratio). Bars with horizontal lines represent interquartile range and median values, with the "whiskers" representing the range. There is a significant increase in L:M ratio in the mild/moderate and severely malnourished patients compared with the controls (*p<0.01, Kruskal-Wallis test). 


Figure 2 .

Figure 2

Figure 2

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Frozen sections of human duodenal mucosa stained with anti-HLA-DR monoclonal antibody (original magnification × 140). A section from a malnourished patient (A) shows intense HLA-DR expression on both lamina propria mononuclear cells and enterocytes. A section from a control patient (B) shows less HLA-DR expression in the lamina propria cells and little detectable HLA-DR expression in enterocytes. 


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