Gut luminal microdialysis

by Solligård, Erik

Background: The aim of the present study was to investigate the influence of a prolonged initial intestinal ischemic insult on transmucosal permeability after a subsequent ischemic event, and whether microdialysis of biomarkers released to the gut lumen is able to reflect changes in intestinal permeability. Methods: The superior mesenteric artery was cross-clamped for 60 min followed by 4 hrs of reperfusion in 16 pigs. Nine pigs had a second cross-clamp of 60 min, and 3 hrs of reperfusion, while 7 were observed for further 4 hrs of reperfusion. Intestinal mucosal integrity was assessed by permeability of 14C-polyethylene glycol (PEG- 4000) over the gut mucosa, luminal microdialysis of lactate, glucose and glycerol, and tonometry. Results: During reperfusion, the PEG-4000 amount in venous blood was two times higher after the first than after the second ischemia (AUC: 44780 (13441-82723) vs. 22298 (12213-49698) counts·min/mL, p=0.026 (mean (range)). There was less lactate detected in the gut lumen after the second ischemia compared to the first (AUC: 797 (412-1700) vs. 1151 (880-1969) mmol·min/L, p=0.02) and a lower maximum concentration (4.8 (2.7-9.4) vs. 8.5 (5.0-14.9) mmol/L, p=0.01). The same pattern was also seen for luminal glycerol and glucose. During the second ischemia, the intestinal mucosal/arterial CO2-gap was identical to the level during the first ischemic episode. Conclusions: A prolonged ischemic insult of the intestine confers protection, in terms of reduced hyperpermeability, against further ischemia. Microdialysis of biomarkers mirrors permeability changes associated with this type of protection. Lactate reflects permeability across the intestinal mucosa more precisely than glycerol. 3