Change in early postoperative intestinal permeability and its relation with systemic inflammatory response

Objectives:To study the effects of glutamine on the change of intestinal permeability and investigate its relationship with systemic inflammatory response in abdominal postoperative patients. Methods: A prospective, randomized, double blind and controlled trial was taken. 20 patients who underwent abdominal surgery were randomized into two groups: Gln group(orally administrated glutamine, 30 g/d, for 7 day, n =10) and placebo group(orally administrated placebo, 30 g/d, for 7 day, n =10). Temperatures and heart rates of all patients were daily recorded during administration. The white blood cell counts and biochemical variables were measured before operation and days 4 and 7 after administration. Serum concentrations of glutamine, endotoxin, diamine oxidase and malondialdehyde and urine lactulose/mannito(L/M) ratio were measured before and the 7th day after administration. Results:The patients in the two groups were comparable prior to the administration. Serum Gln concentration was significantly decreased in placebo group and increased in Gln group after 7 days of administration. Urine L/M ratio was significantly increased in placebo group and decreased in Gln group. The serum concentrations of endotoxin, diamine oxidase and malondialdehyde were significantly decreased in Gln group when compared with those in placebo group. Temperatures, heart rates and WBC counts were significantly lower in Gln group than in placebo group. Conclusions:The gut is one of the sources of the systemic inflammatory response in abdominal postoperative patients and the glutamine can decrease the intestinal permeability,maintain the intestinal barrier and attenuate the systemic inflammatory response in the early period of postoperative patients.