Gut Lymphangiopathy: Adding Fuel to the Fire in Chronic Liver Disease

Abstract

The splanchnic inflammation inchronic liver disease increases intestinal angiogenesis. In the current study our aim was d emonstrating that the small bowel lymphangiogenesis is associated with angiogenesis in chronic cholestasis in the rat. A stereological study of the lymphatic microcirculation in the small intestine was performed in cholestatic rats. P ortal enteropathy in cholestasis increases lymphatic microvessels in the mucosa and submucosa layers. Thus, the lymphatic microvessel volume fraction was superior (p < 0.001) in the mucosa (0.16 ± 0.01) and submucosa (0.16 ± 0.01), in regard to the muscle layer 0.015 ± 0.01. The lymphatic microvessel length density was higher in the mucosa (76.89 ± 2.86 mm -2 ; p < 0.001) and submucosa (14.87 ± 2.86 mm -2 ; p < 0.01), in relationship to the muscle layer (5.04 ± 2.92 mm -2 ). These alterations predominate in the duodenum (volume fraction: 0.10 ± 0.01 and length density: 33.55 ± 5.98 mm -2 ) and ileum (volume fraction: 0.16 ± 0.01 and length density: 38.62 ± 6.07 mm -2 ). This study demonstrates the predominance of an increased lymphangiogenic response in both end sides of the small bowel associated with chronic liver disease. Since the porto-systemic venous collateral circulation in the chronic liver insufficiency is developed in the ends of the gastrointestinal tract, the excessive duodeno-ileal lymphangiogenesis could suggest the development of amesenteric-systemic lymphatic bypass in the chronic portal hypertension.