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Mannitol and lactulose were used as probe molecules to measure intestinal permeability in children with active small-bowel Crohn's disease and with untreated coeliac disease. Mannitol and lactulose were administered by mouth in a moderately hypertonic solution (580 mmol (mosmol)/l), and results were expressed as the ratio of the molecules excreted in urine over five hours. Patients with Crohn's disease had a sixfold increase in permeability (due to increased lactulose permeability) and those with coeliac disease a fivefold increase (due to decreased mannitol permeability).From these results the test offers potential as a noninvasive investigation in children with small-bowel disease. IntroductionHydrophilic molecules permeate the healthy small-bowel mucosa at rates which depend on their molecular size.1 2 In clinical practice various non-metabolised sugars used to study adult populations indicate that in villous atrophy there is a decreased absorption of small molecules and an increased absorption of larger molecules.3 Other studies show that the small-bowel mucosa is more permeable to large molecules in patients with eczema and food allergy5 and also during the neonatal period.6 We were interested in this technique as a non-invasive investigation for children and have evaluated two probe molecules, mannitol and lactulose, to measure intestinal permeability in normal subjects and in two differing conditions of abnormal small-bowel mucosa-untreated coeliac disease and active Crohn's disease.

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