Korean J Med.  2019 Dec;94(6):511-518. 10.3904/kjm.2019.94.6.511.

Bowel Wall Thickness, Elasticity, Intestinal Permeability, and Inflammatory Cytokines in Patients with Cirrhosis and Ascites

• Lee SH
• Kwon HJ
• Kim NH
• Kim HJ
• Cho YK
• Jeon WK
• Park EH
• Kim BI

• KMID: 2467217
• DOI: http://doi.org/10.3904/kjm.2019.94.6.511

Abstract

BACKGROUND/AIMS
Previous studies have reported that endotoxemia is associated with pathogenesis and complications in cirrhosis. Endotoxin stimulates the secretion of inflammatory cytokines, which contributes to the development of complications. In addition, endotoxin easily invades the gut barrier system because of the increased intestinal permeability due to portal hypertensive enteropathy. In this report, we explored changes in cytokine levels and intestinal permeability and measured the thickness and elasticity of the bowel wall using ultrasonography in cirrhotic patients.
METHODS
We enrolled 40 patients with cirrhosis classified as Child-Pugh B or C and 20 healthy volunteers. Abdominal ultrasonography examinations were used to evaluate bowel wall parameters in the ascending colon and terminal ileum. Intestinal permeability was measured using dual sugar absorption tests with lactulose and mannitol. Levels of tumor necrosis factor (TNF)-α and IL-10 were determined from blood samples. We compared these outcomes between cirrhotic patients and healthy controls and between Child-Pugh B and C patients. In addition, we explored the correlation between cytokine levels, intestinal permeability ratio, and bowel wall parameters in cirrhotic patients.
RESULTS
In cirrhotic patients, the ascending colon wall elasticity decreased (20.4 vs. 10.9 kPa, p = 0.048) and the terminal ileum wall thickness increased (4.2 vs. 1.9 mm, p < 0.001). The intestinal permeability ratio and levels of the cytokines TNF-α and IL-10 increased (0.219 vs. 0.017, p < 0.001; 22.47 vs. 13.48 pg/mL, p < 0.001; and 14.91 vs. 8.57 pg/mL, p = 0.019, respectively) in cirrhotic patients. However, there were no significant differences between Child-Pugh classes and no significant correlations between bowel wall parameters and intestinal permeability or cytokine levels.
CONCLUSIONS
Ultrasonography revealed bowel wall thickening and decreases in elasticity; in addition, intestinal permeability and cytokine levels increased in cirrhotic patients compared with healthy controls.

Keyword

Liver cirrhosis; Permeability; Intestines; Ultrasonography

MeSH Terms

Absorption
Ascites*
Colon, Ascending
Cytokines*
Elasticity*
Endotoxemia
Fibrosis*
Healthy Volunteers
Humans
Ileum
Interleukin-10
Intestines
Lactulose
Liver Cirrhosis
Mannitol
Permeability*
Tumor Necrosis Factor-alpha
Ultrasonography
Cytokines
Interleukin-10
Lactulose
Mannitol
Tumor Necrosis Factor-alpha