Introduction
Background of the Study
The term bacterial translocation (BT) first referred to a transmission of viable bacteria from gastrointestinal tract to the mesenteric lymph nodes. However, this notion was later widened and included the passage of non-viable bacteria or other products with the intestinal endotoxin. The intestine serves two main functions: first, it selects nutrients from the intestinal lumen into the bloodstream, and, second, prevents the penetration of harmful substances into the body1. Moreover, BT can occur in healthy people and be a normal physiological state without any further consequences. Nevertheless, BT has also been demonstrated in several diseases and has been associated with various infectious complications1. In this case, bacterial translocation often aggravates the effects of diseases.
Problem statement and Research Questions
Thus, BT may impact the functioning of the body, including damaging its vital organs such as liver and pancreas. Therefore, there is a need to explore intervention measures and therapies to help manage and reduce the effects of this disorder. In order to study this problem, the research will seek to answer various questions. First, it will examine the effects of cirrhosis on the development of BT. Then, it will describe the predominant factors of gut permeability among ill patients. Finally, it will determine the most effective therapeutic approaches to manage and treat the bacterial translocation.
Limitations, Delimitations, and Assumptions
This study has various limitations, delimitations, and assumptions that affect the results obtained. First, the origin of bacterial translocation can be caused simultaneously by several factors. Moreover, the results of some treatment methods of this disease are controversial, and, therefore, cannot be applied everywhere. The research is limited to the investigation of humans in the case of liver cirrhosis, and the examination of various animal species in the selection of the treatment for patients with BT. The study is based on several assumptions:
- A healthy intestinal barrier critically affects the functioning of the body;
- Some treatments (probiotics) are effective for prophylactic purposes, and some (antibiotics) are aimed at a complete cure;
- Animal models are of great importance for examination in the field of bacterial translocation.
The aim of this research is to examine existing nutrition-based strategies for the prevention, treatment, and management of a condition such as bacterial translocation.
Literature
Bacterial Translocation (BT)
The notion of bacterial translocation was described in 1979 by the scientists Garlington and Berg. They introduced this phenomenon as a passage of viable and, later, non-viable bacteria through the epithelial mucosa into the lamina propria and other normally sterile organs1. The occurrence of bacterial translocation can be affected by several factors, including treatment with antibiotics. For example, some studies have shown that excessive long-term treatment with antibiotics to disrupt the gut microbiota may lead to BT2. Another concept worth mentioning is minor bowel hypomotility, which also leads to BT in certain cases. Often, this condition is manifested in patients suffering from various gastrointestinal symptoms: nausea, pain, and vomiting. Moreover, it is important to understand that a disruption of the barrier function of the intestinal mucosa also results in bacterial translocation3. This disruption may provoke an inflammatory process of the mucosa. Furthermore, the alterations in the intestinal flora affect the development of BT. The intestinal flora includes microorganisms disruption, leading to various consequences, including the development of acute pancreatitis and bacterial translocation.
At the moment, scientists have identified several types of treatment in order to manage or reduce BT. First of all, by applying symbiotics, prebiotics, and probiotics, it is possible to maintain a stable microecology of the patient’s intestine. For example, probiotics are live non-pathogenic macroorganisms that have shown positive results in reducing the frequency of infections after surgery among patients. Secondly, enteral nutrition, early resuscitation, immunonutrient, and antioxidants are also used to enhance the intestinal epithelial barrier and prevent intestinal damage. In the same way as probiotics, enteral nutrition helps to reduce the incidence of various infections in patients1. Moreover, this type of treatment also demonstrated a reduction in mortality among patients with acute pancreatitis.
Understanding the Liver Disease
In order to ensure a healthy gut microbiome, probiotics are administered to the patient in minimal amounts. The effectiveness is confirmed by the positive results which consist in reducing the number of infectious diseases among patients after surgery. However, some studies have shown that probiotics are not able to qualitatively reduce the risk of infectious diseases among patients with, for example, acute pancreatitis1. Thus, taking into account the conflicting results, the researchers agreed that this method would be effective if used for therapeutic purposes. Consequently, applying probiotics among seriously ill patients will not lead to any positive results. Nevertheless, this type of treatment among patients during the preoperative period does reduce the risk of developing infections.
Liver cirrhosis is a serious and widespread disease that leads to more than one million deaths per year. It is believed that the development of fibrosis is the ultimate reaction to damage and inflammation of the liver due to various factors, including viral infection4. Studies suggest that patients with liver cirrhosis have highly activated macrophages. This is caused by several reasons, including a violation of the intestinal barrier. This hypothesis is confirmed by researches that revealed that the markers of macrophage activation coincided with the markers of bacterial translocation4. Moreover, other investigations have shown that bacterial translocation manifests itself in sterile extra-intestinal areas in patients with liver cirrhosis1. Thus, it can be concluded that bacterial translocation has a certain effect on the pathology of liver cirrhosis.
Another common cause of liver cirrhosis in patients is excessive alcohol consumption. The effect of alcohol on liver diseases is quite obvious, since it is the liver that processes it. Thus, during the processing of alcohol, various harmful substances and toxins are produced and may harm the functioning of the liver. Therefore, the more a person consumes alcohol, the more these harmful substances will be produced and the more dreadful the liver damage will be.
Immunology and other Response Interventions
One of the ways to treat and manage bacterial translocation is considered to be selective digestive tract decontamination (SDD). This method involves the use of various types of antibiotics aimed at eliminating pathogenic intestinal bacteria. It is believed that this method leads to a restriction of bacterial translocation and to a reduction in the risk of intestinal infections. Studies have shown that SDD also reduces the rate of pneumonia infections, which is associated with artificial respiration in intensive care patients1. One of these researches, which included the examination of surgical and non-surgical patients, proved the advantage of this method in the overall survival of patients1. Thus, SDD prevents the development of inflammatory diseases and reduces the risk of BT.
Cytokines in Systems Disorders
Bacterial translocation may also correlate with other comorbidities, including endotoxemia: an inflammatory infection caused by gram-negative bacteria. Moreover, various studies have shown that intestinal bacteria translocate in extra-intestinal areas in patients with various diseases, including acute pancreatitis. In addition, as mentioned earlier, BT is also observed in patients suffering from liver diseases. For example, researchers have found that the level of endotoxins is higher in patients with liver cirrhosis than in all others4. Thus, it can be concluded that bacterial translocation can influence and stimulate various concomitant diseases and complications.
Cholestasis Animal Models
It is important to consider some models used in connection with the evaluation of bacterial translocation and its further therapy. In particular, it is worth paying attention to the model associated with the study of different breeds of mice5. Thus, many researches that have used an animal model to find an effective therapy for BT have shown that various manipulations lead to resistance to colitis6. Tests conducted on rodents have shown that the barrier function disruption of the intestine also adversely affects inflammation and BT7. Other studies that have examined goslings have shown how various diseases can affect the development of inflammatory processes and BT8. Thus, the researchers found that goslings with gout showed signs of depression; after their death, various inflammatory formations were also found.
Chapter Summary
Summarizing, it is safe to conclude that bacterial translocation begins to manifest itself as a consequence of various diseases. Thus, cirrhosis, gout, pancreatitis and many other diseases lead to the appearance of inflammatory processes. As a result of these processes, the passage of bacteria begins, which are BT. Moreover, it was possible to trace that at the moment, there are several effective ways to treat, manage, and prevent BT. These include probiotic treatment, enteral nutrition, and selective digestive tract decontamination.
Methodology
In order to investigate the problem of bacterial translocation, various methods were used. When studying the links between liver cirrhosis and BT, 101 cirrhotic and 31 healthy control patients were examined4. In order to evaluate the effect of antibiotics on the development of bacterial translocation, an animal model was used, in which mice were given oral antibiotics2. To analyze the various ways of treating BT, the relevant literature and researches were examined. Moreover, various examples of using the animal model were studied to better understand the impact of diseases on the BT process.
Findings, Data Analysis, and Results
Several findings suggest data for determining the outcomes of different treatments and the impact of diseases on the development of BT. Examination of patients with cirrhosis of the liver resulted in deaths of 21 patients and demonstrated a survival rate of 71%4. Moreover, throughout the study, it was noted that the markers of BT coincide with the markers of macrophage activation. It was also proved that the use of various antibiotics led to bacterial translocation, as well as to various inflammatory processes. In addition, various ongoing tests have shown how intestinal injury can affect the development of inflammatory processes and further bacterial translocation9. Therefore, the results showed the causes of bacterial translocation, methods for its treatment and management, as well as the impact that various factors have.
Discussion, Implications, Conclusion, and Recommendations
To sum up, not all the results of the study showed effective dynamics of treatment of bacterial translocation. However, mixed results, such as treatment with probiotics, have proven that this method can be used as a preventive measure. Also, the analysis of the method of selective digestive tract decontamination proved that it would lead to a reduction in the risk of various infections. Animal studies have made it possible to assess the causes and consequences of BT without harm to human health. Various findings and results provide the scientific community with many options for the treatment and prevention of bacterial translocation.
References
Assimakopoulos S F, Triantos C, Thomopoulos K, Fligou F, Maroulis I, Marangos M, Gogos C A. Gut-origin sepsis in the critically ill patient: pathophysiology and treatment. Infection, 2018;46(6): 751-760.
Knoop K A, McDonald K G, Kulkarni D H, Newberry R D. Antibiotics promote inflammation through the translocation of native commensal colonic bacteria. Gut, 2016; 65(7): 1100-1109.
Dorshow R B, Hall-Moore C, Shaikh N, Talcott M R, Faubion W A, Rogers T E,… Tarr P I. Measurement of gut permeability using fluorescent tracer agent technology. Scientific Reports, 2017; 7(1): 1-8.
Rainer F, Horvath A, Sandahl T D, Leber B, Schmerboeck B, Blesl A,… Stadlbauer V. Soluble CD 163 and soluble mannose receptor predict survival and decompensation in patients with liver cirrhosis, and correlate with gut permeability and bacterial translocation. Alimentary Pharmacology & Therapeutics, 2018; 47(5): 657-664.
Oyama N, Winek K, Bäcker-Koduah P, Zhang T, Dames C, Werich M,… Dirnagl U. Exploratory investigation of intestinal function and bacterial translocation after focal cerebral ischemia in the mouse. Frontiers in Neurology, 2018; 9: 937.
Ahmad R, Sorrell M F, Batra S K., Dhawan P, Singh A B. Gut permeability and mucosal inflammation: bad, good or context dependent. Mucosal Immunology, 2017; 10(2): 307-317.
González-González M, Díaz-Zepeda C, Eyzaguirre-Velásquez J, González-Arancibia C, Bravo J A, Julio-Pieper M. Investigating gut permeability in animal models of disease. Frontiers in Physiology, 2019; 9: 1962.
Xi Y, Yan J, Li M, Ying S, Shi Z. Gut microbiota dysbiosis increases the risk of visceral gout in goslings through translocation of gut-derived lipopolysaccharide. Poultry science, 2019; 98(11): 5361-5373.
Dutta D, Methe B, Amar S., Morris A, Lim S H. Intestinal injury and gut permeability in sickle cell disease. Journal of Translational Medicine, 2019; 17(1): 1-4.
Wilms E, Troost F J, Elizalde M, Winkens B, de Vos P, Mujagic Z,… Masclee A A. Intestinal barrier function is maintained with aging–a comprehensive study in healthy subjects and irritable bowel syndrome patients. Scientific Reports, 2020; 10(1): 1-10.