16 BILE AND BOWEL IN BILIARY ATRESIA: PRELIMINARY DATA OF AN EXPLORATIVE STUDY.
Marc den Heijer, Daan van Wessel, Ruben de Kleine, Janneke Bruggink, Henkjan Verkade, Jan Hulscher
University Medical Center Groningen, Groningen, Netherlands

Abstract

Aim of the study: Biliary atresia (BA) results in cholestasis and, if untreated, in rapidly progressing liver injury. The absence of bile acids in the bowel might have profound impact on intestinal permeability and subsequent translocation of bacteria and bacterial products – which may in turn aggravate liver injury. We performed a pilot study to gain insight in the interrelation between bile acids and gut wall integrity.

Methods: We collected pre-operative blood samples from BA patients and controls undergoing inguinal hernia repair. We compared markers for bacterial translocation (soluble CD14 [sCD14], lipopolysaccharide [LPS] and lipopolysaccharide binding protein [LBP]), tight junction functioning (Claudin 3), inflammation (Interleukine-6 [IL-6]) and enterocyte damage (Intestinal Fatty Acid Binding Protein [I-FABP]). Data were compared with the Mann-Whitney U-test. We correlated data with the AST to Platelet Ratio Index (APRI) score as marker for liver fibrosis.

Main results: We included nine BA patients (median age 64 days [range 23-93], 4 boys, 8 terms) and 11 controls (median age 118 days [range 87-316], 10 boys, 3 terms). We found significant differences in sCD14 and Claudin 3 levels (table 1). Claudin 3 and APRI score (rs=.71, p=.03) correlated significantly. Moreover, age at sample and APRI score correlated significantly in BA patients (rs=.77, p=.02).

Conclusions: In the absence of bile, tight junction functioning, and thus gut wall integrity, seems impaired. The pathophysiology behind these phenomena are subject for further study.

 

BA median (range)

Control median (range)

P-value

sCD14 (µg/ml)

1.6 (1.0-9.8)

1.0 (0.5-2.0)

<.01

LPS (mEU/ml)

1.65 (0.00-8.81)

4.86 (0.00-30.61)

.41

LBP (µg/ml)

40 (14-469)

39 (1-222)

.37

Claudin 3 (ng/ml)

96 (81-148)

64 (53-120)

.01

IL-6 (pg/ml)

0 (0-58)

0 (0-1176)

.88

I-FABP (pg/ml)

4307 (1225-9714)

6725 (4599-7665)

.55


Website
Yes