Evaluation of intestinal permeability in patients with inflammatory bowel disease using lactulose and measuring antibodies to lipid A.

Abstract

This study looked at the intestinal permeability and the immune response to enteric bacterial antigens in patients with inflammatory bowel disease (IBD). They were evaluated by using a lactulose tolerance test and measuring blood anti-lipid A antibody concentrations, respectively.The lactulose tolerance tests were performed 22 times in 14 patients with Crohn's disease (CD), 19 times in 12 patients with ulcerative colitis (UC), and 12 times in 12 healthy controls. Blood lactulose concentrations were measured after oral administration every two hours for eight hours, also blood C reactive protein concentrations and anti-lipid A antibody concentrations were measured just before lactulose administration. Blood lactulose concentrations were significantly higher in patients with CD than in the controls from two to eight hours after administration, while in UC they were significantly higher than in the controls from six to eight hours. Maximum blood lactulose concentrations in each tolerance test in patients with the active phase significantly exceeded those in the inactive phase of either CD or UC. A significant correlation was also seen between the maximum blood lactulose concentrations and the C reactive protein concentrations. Blood anti-lipid A antibody concentrations in patients with CD were significantly higher than in the controls as well as in patients with UC in immunoglobulin (Ig) A class and IgG class. In UC they were significantly higher than in the controls in IgA class. But, they were not related to the severity of the disease of either CD or UC, and not correlated significantly with the maximum blood lactulose concentrations in either CD or UC. The intestinal permeability and the immune response to enteric bacterial antigens in patients with inactive CD were significantly increased over those in the controls as well as in patients with inactive UC. These findings suggest that an increase of the intestinal permeability and that of producing antibodies to enteric bacterial antigens are both important for the pathogenesis of IBD, and that the characteristics of CD and UC differ.

Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis ‐ a pilot study

“…[16][17][18] The entry of such molecules into the enterohepatic circulation may, in some patients, be related to the enteric dysbiosis and increased intestinal permeability associated with inflammatory bowel disease (IBD), a condition diagnosed in 75% of those with PSC. [19][20][21][22][23] Further supporting the PSC microbiota hypothesis is the observation, for example, that patients with PSC often have a leucocyte differential exhibiting increased neutrophils, even in the absence of signs or symptoms of acute cholangitis, suggesting circulation of endotoxins or other immunoactive molecules. 24 Collectively, these and animal model 25,26 findings point toward a role for bacteria and bacterially derived molecules in the aetiopathogenesis of PSC.…”

Increased Intestinal Permeability and Decreased Barrier Function: Does It Really Influence the Risk of Inflammation?

“…Paracellular intestinal permeability estimated by the Ussing chamber method was increased even in patients with inactive IBD [5], although the maximum blood lactulose concentrations were higher in patients with active diseases [6]. A significant correlation was noted between the maximum blood lactulose concentrations and serum CRP levels [6]. Increased intestinal permeability was also detected in patients with ulcerative colitis (UC) in remission [7].…”

“…Patients with Crohn's disease (CD) exhibit marked increases in intestinal permeability assessed by the lactulose-mannitol (L/M) test [4]. Paracellular intestinal permeability estimated by the Ussing chamber method was increased even in patients with inactive IBD [5], although the maximum blood lactulose concentrations were higher in patients with active diseases [6]. A significant correlation was noted between the maximum blood lactulose concentrations and serum CRP levels [6].…”

Glutamine-enriched total parenteral nutrition in patients with inflammatory bowel disease

“…When TPN is given, further impairment of the intestinal epithelial barrier must be considered (van der Hulst et al, 1993, Oriishi et al, 1995. IBD patients with acute exacerbation, bowel rest and TPN may, therefore, have a particular need for enterocyte support, for example, by glutamine (gln) administration (Scheppach et al, 1994).…”