Host immune responses and intestinal permeability in patients with jaundice

Abstract

Abstract Background Systemic endotoxaemia is implicated in the development of complications associated with obstructive jaundice. The aims of these studies were to assess the systemic immune response to intervention in patients with jaundice and to compare the effects of surgical and non-surgical biliary drainage on host immune function and gut barrier function. Methods In the first study, 18 jaundiced and 12 control patients were studied to assess systemic immune responses before and after intervention. In the second study, immune responses and gut barrier function were assessed following surgical and non-operative biliary decompression in 45 patients with jaundice. Results Endotoxin antibody concentrations fell significantly in patients with jaundice immediately after surgical intervention, but not after non-operative biliary drainage. This decrease was associated with a significant increase in serum P55 soluble tumour necrosis factor (sTNF) receptor concentration (5·3 versus 10·5 ng/ml; P < 0·001), urinary excretion of P55 TNF receptors (21·4 versus 78·8 ng/ml; P = 0·002) and intestinal permeability (lactulose : mannitol ratio 0·032 versus 0·082; P = 0·048). Intestinal permeability was significantly increased in patients with jaundice compared with controls (0·033 versus 0·015; P = 0·002). Conclusion These data suggest that obstructive jaundice is associated with impaired gut barrier function and activation of host immune function that is exacerbated by intervention. Surgery causes an exaggerated pathophysiological disturbance not seen with non-operative biliary drainage procedures.