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Korean J Med > Volume 94(6); 2019 > Article
The Korean Journal of Medicine 2019;94(6): 511-518.
복수를 동반한 간경변 환자의 장관벽 두께, 탄성도, 장 투과성 및 염증성 사이토카인의 변화
이상혁1, 권헌주2, 김남희1, 김홍주1, 조용균1, 전우규1, 박은혜1, 김병익1
1성균관대학교 의과대학 강북삼성병원 소화기내과
2성균관대학교 의과대학 강북삼성병원 영상의학과
Bowel Wall Thickness, Elasticity, Intestinal Permeability, and Inflammatory Cytokines in Patients with Cirrhosis and Ascites
Sang Hyuk Lee1, Heon-Ju Kwon2, Nam Hee Kim1, Hong Joo Kim1, Yong Kyun Cho1, Woo Kyu Jeon1, Eun Hye Park1, Byung Ik Kim1
1Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding Author: Byung Ik Kim ,Tel: +82-2-2001-8553, Fax: +82-2-2001-2610, Email: bik.kim@samsung.com
Received: April 16, 2018;   Revised: June 19, 2018;   Accepted: November 14, 2018.
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.
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.
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.
Ultrasonography revealed bowel wall thickening and decreases in elasticity; in addition, intestinal permeability and cytokine levels increased in cirrhotic patients compared with healthy controls.
Keywords: Liver cirrhosis; Permeability; Intestines; Ultrasonography
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