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The Annals of Thoracic Surgery, Vol 55, 1080-1086, Copyright © 1993 by The Society of Thoracic Surgeons
SK Ohri, I Bjarnason, V Pathi, S Somasundaram, CT Bowles, BE Keogh, A Khaghani, I Menzies, MH Yacoub and KM Taylor
Gastrointestinal damage occurs in 0.6% to 2% of patients after
cardiopulmonary bypass (CPB), and carries a mortality of 12% to 67%. The
incidence of subclinical gastrointestinal damage may be much greater. We
examined the effects of nonpulsatile, hypothermic CPB on intestinal
absorption and permeability in 41 patients. Bowel mucosal saccharide
transport and permeation were evaluated using 100 mL of an oral solution
containing 3-O-methyl-D-glucose (0.2 g), D-xylose (0.5 g), L-rhamnose (1.0
g), and lactulose (5.0 g) to assess active carrier- mediated, passive
carrier-mediated, transcellular, and paracellular transport, respectively,
with a 5-hour urine analysis. Patients were studied before, immediately
after, and 5 days after CPB. Immediately after CPB there was a decrease in
urinary excretion of 3-O-methyl-D- glucose (from 34% +/- 2.2% to 5.2% +/-
0.7%; p < 0.0001), D-xylose (from 25.4% +/- 1.4% to 4.1% +/- 0.8%; p
< 0.0001), and L-rhamnose (from 8.3% +/- 0.6% to 2.6% +/- 0.4%; p <
0.0001). The permeation of 3- O-methyl-D-glucose and D-xylose returned to
normal levels 5 days after CPB, but that of L-rhamnose remained
significantly below pre-CPB values at 6.6% +/- 0.5% (p = 0.004). However,
the permeation of lactulose increased after CPB (from 0.35% +/- 0.04% to
0.59% +/- 0.1%; p = 0.018), and the lactulose/L-rhamnose gut permeability
ratio increased markedly (from 0.045 +/- 0.04 to 0.36 +/- 0.08; normal =
0.06 to 0.08; p = 0.004). Patients who had a CPB time of 100 minutes or
more had a greater increase in gut permeability (p = 0.049).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Cardiopulmonary bypass impairs small intestinal transport and increases gut permeability
Department of Cardiothoracic Surgery, Hammersmith Hospital, London, United Kingdom.
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