Effect of Enteral Nutrition on Intestinal Permeability in Critically III Patients -Preliminary Report-

It has been reported that intravenous injection of endotoxin increases intestinal permeability in human, and that total parenteral nutrition promotes bacterial translocation from the gut. In the present study, the effect of enteral nutrition on intestinal permeability and its relationship to plasma endotoxin levels were evaluated. Intestinal permeability was assessed in six stressed patients who were intubated for acute respiratory failure. The examination was performed before and after 7 days of feeding using the dual-sugar intestinal permeability test, with lactulose and mannitol as markers. Plasma endotoxin levels were also measured by the endotoxin-specific colorimetric limulus test before and after an enteral diet. The mean±SD lactulose to mannitol excretion ratio (L/M ratio), a permeability index, before enteral nutrition was 0.108±0.111, which was extremely high compaired to reported value of healthy volunteers. This value was declined to 0.042±0.067 after enteral nutrition, although p value (0.068) was not reached statistical significance. The mean plasma endotoxin level, which may have been related to concomitant respiratory infection, was 10.08±2.80 pg/ml before, and 18.48±12.39 pg/ml after enteral feeding (p=0.075). Despite the elevation of endotoxin, there was a tendency to meke intestinal permeability improve after enteral feeding. This suggests that the increased progression of intestinal permeability due to endotoxemia, fasting, and acute stress might be prevented by enteral feeding.

Enteral nutrition

Intestinal permeability

Endotoxin

Endotoxemia

Lactulose-mannitol differential sugar absorption