Assessment of Hypolactasia and Site-Specific Intestinal Permeability by Differential Sugar Absorption of Raffinose, Lactose, Sucrose and Mannitol

Abstract

The sugar absorption test is a non-invasive test for investigating intestinal permeability by simultaneous measurement of four probe sugars. In this study, we evaluated the utility of raffinose, lactose, sucrose and mannitol as probe sugars and calculated their urinary recovery as a percentage of ingested dose (mol/mol) and the recovery ratios of raffinose/mannitol, lactose/ raffinose and sucrose/raffinose. The reference ranges for these ratios, established from 39 healthy volunteers, are 0.005-0.015, 0.13-0.63 and 0.09-0.47, respectively. This sugar absorption test was performed in three patient groups. i) In 109 patients with aspecific gastrointestinal symptoms of whom intestinal histology was studied by duodenal biopsies: the urinary raffinose/mannitol recovery ratio highly correlated with gradation of duodenal damage; the sensitivity and specificity of the raffinose/mannitol ratio for detection of intestinal damage were 93% and 91%, respectively, using a cut-off level of 0.020. ii) In 70 patients in whom intestinal lactase activity was investigated by the lactose tolerance test: the urinary lactose/raffinose recovery ratio provided high diagnostic accuracy for hypolactasia (sensitivity 81% and specificity 89% at a cut-off level of 0.70). In analogy with the lactose/raffinose ratio, we suppose that the sucrose/raffinose ratio can be used as a marker of hyposucrasia. iii) In 40 patients with localized small intestinal damage, Crohn's disease of the ileum (n = 21) and celiac disease with histologically proven duodenal damage (n = 19): the raffinose/mannitol recovery ratio was increased in 100% of patients with celiac disease and in 81% of patients with Crohn's disease; increased lactose/raffinose recovery ratio (hypolactasia) and increased sucrose/raffinose (hyposucrasia) were present in 89% and 95% of celiac patients and 19% and 0% of Crohn's disease patients, respectively. The combination of the raffinose/mannitol ratio and sucrose/raffinose ratio appears to be an indication of the distribution of intestinal damage.

Disaccharidase activity in children with inflammatory bowel disease

“…Elemental diet also shows immunological effects by increasing the supply of food and macromolecular antigens, changing intestinal bacterial flora, inhibiting intestinal loss of lymphocytes, and decreasing synthesis of inflammatory mediators. An adequate dietary regimen leads to improved protein and energetic balance, correction of micronutrient deficiency (vitamins, trace elements), and decreased intestinal loss of nutrients (6)(7)(8)(9).…”

Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine

“…In our previous study, we applied an enzymatic method to detect the disaccharides lactose and sucrose mainly in PM urine samples, and a correlation was found between lactose concentration and the presence of BPN or BNX. A similar enzymatic method had been previously used in the assessment of intestinal permeability of patients with hypolactasia, celiac disease, or inflammatory bowel disorders . Although the enzymatic method itself is feasible and cost‐effective, a major limitation of our previous study was the lack of detailed information concerning the subjects studied, as we had access to laboratory results only, and not to autopsy findings or previous health records.…”

Enzymatic assays for detecting lactose and sucrose in urine to reveal intravenous drug abuse with emphasis on buprenorphine

“…Interpretation of the results may also be complicated by diseases like coeliac disease and hypolactasia . During these conditions intestinal damage leads to uncontrolled intestinal permeability which in turn increases the disaccharide concentration in the blood, and eventually in the urine.…”

“…In the drug negative clinical group, the lactose level was low in all but one case, in which the lactose concentration was moderately elevated (Figure ). This moderate elevation could be explained by possible defects in intestinal absorption or hydrolysis of lactose . In the BPN/BNX positive clinical group, lactose levels were mainly low, but some moderately and significantly elevated values were detected (Figure ), which could imply intravenous administration of BPN/BNX.…”