Alterations in Intestinal Microbial Flora and Human Disease

Mohamed Othman; Roberto Agüero; Henry C. Lin

Disclosures

Curr Opin Gastroenterol. 2008;24(1):11-16. 

In This Article

Gut Bacteria and Abnormal Intestinal Permeability in Burn Injury

Animal studies have long established that burns or thermal injury caused an increase in bacterial translocation.[66,67] Burn injuries induce epithelial apoptosis leading to atrophy of the intestinal mucosa followed by bacterial translocation.[68] What is observed is an 'imbalance' in the microflora following thermal injury in rats with decreased proportions of Bifidobacterium spp. relative to the abundance of Gram-negative organisms (e.g. E. coli), followed by bacterial translocation and sepsis.[69,70] Most notable was that animals supplemented with oral Bifidobacterium spp. had a decreased incidence of bacterial translocation.[69]

Increased intestinal permeability or leaky gut is also more common among burn victims.[71] The severity of the burn injury was found to directly correlate with the degree of increased intestinal permeability.[72] Although it was demonstrated in animal models that bacteria translocate to mesenteric lymph nodes and enter the circulation through portal blood,[70] a prospective human trial failed to detect a significant level of bacteria, bacterial endotoxin or inflammatory markers in the portal circulation of patients with major trauma in the presence of inflammatory-mediated lung injury.[73] This finding led to the recent gut-lymph hypothesis, which argues that endothelial permeability is selectively higher in the mesenteric lymph nodes and that portal circulation passes inflammatory markers via the thoracic duct to the lung rather than through the liver, causing acute lung injury.[74] This hypothesis is further supported by the prevention of acute lung injury in posthemorrhagic rats by ligation of the mesenteric lymphatic system.[75]

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