New lights on the pathogenic mechanisms of liver cirrhosis with ascites

The pathogenic mechanisms implicated in the failure of intestinal barrier in cirrhosis have not been fully elucidated as yet and remains to be investigated.

A research article to be published on 28 June 20008, in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Shin and Dr. Lee investigated whether intestinal macromolecular permeability is altered in patients liver cirrhosis and its relationship with the serum TNF-α level and nitric oxide (NO) metabolite level in urine to clarify the role of intestinal macromolecular permeability, the serum TNF-α level and nitrite level in urine to the development of liver cirrhosis with ascites. The results suggest that increased intestinal macromolecular permeability and NO are probably of importance in the pathophysiology and progression of liver cirrhosis with ascites, and furthermore, increased intestinal permeability may be a contributory factor in the development of encephalopathy in liver cirrhosis.

In this study, there were no concomitant infections and a significantly higher TNF-α level in cirrhotic patients without ascites than healthy control subjects or patients with liver cirrhosis (LC) with ascites was seen; thus, there was a tendency for a negative correlation between the TNF-α level and Child-Pugh class in the advanced stage of LC. In advanced cirrhosis, hepatic damage and inflammation are reduced due to a decreased liver reserve and marked fibrosis, and consequently, ALT levels decrease. Additionally, diminished amounts of cytokine-producing cells such as hepatocytes and Kupffer cells may lead to a decrease of TNF-α production. In the current study, intestinal permeability index (%) and urinary nitrite excretion were significantly higher in patients with LC with ascites as compared to patients with LC without ascites or healthy control subjects, with a significant correlation.

Reference: Lee S, Son SC, Han MJ, Kim WJ, Kim SH, Kim HR, Jeon WK, Park KH, Shin MG. Increased intestinal macromolecular permeability and urine nitrite excretion associated with liver cirrhosis with ascites. World J Gastroenterol 2008; 14(24):3884-3890
http://www.wjgnet.com/1007-9327/14/3884.asp

Correspondence to: Myung-Geun Shin, MD, PhD, Departments of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun 519-809, Korea. mgshin@chonnam.ac.kr
Telephone: +82-61-3797950 Fax: +82-61-3797984

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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