Intestinal permeability in cirrhotic patients with and without ascites

Objective. It has been suggested that increased intestinal permeability plays a pathogenic role in bacterial infections, such as spontaneous bacterial peritonitis, in patients with liver cirrhosis. The aim of this study was to assess whether intestinal permeability is altered in cirrhotic patients with and without ascites. Material and methods. Intestinal permeability was assessed by a Cr-51-EDTA permeability test in 20 cirrhotic patients ( 10 with and 10 without ascites) along with 20 age- and gender-matched healthy controls. In six patients with ascites, the test was performed before and after therapeutic paracentesis. Results. The median (IQR) 24-h urinary excretion of 51 Cr-EDTA was higher in patients with cirrhosis (1.94% (1.21 - 2.70%)) compared with that in controls ( 1.40% (1.09 - 1.99%); p < 0.05). Patients with (2.05% (1.50 - 3.46%); p < 0.05) but not those without ascites ( 1.94% (1.13 - 2.53%); p > 0.1) had significantly higher excretion values compared with those of controls. Only one patient without ascites and a total of four patients with ascites had increased intestinal permeability (Cr-51-EDTA excretion > 95% confidence than that of controls; p > 0.1). Paracentesis did not affect urinary Cr-51-EDTA excretion significantly (1.69% (1.16 - 2.86%) versus 1.30% ( 1.08 - 1.79%) before and after, respectively; p > 0.1). No significant correlation was found between clinical severity scores for liver disease and intestinal permeability. Conclusions. Only a small proportion of patients with liver cirrhosis have increased intestinal permeability and it is unlikely that this plays any major role in predisposing these patients to infections.