Intestinal permeability assessed by excretion ratios of two molecules: results in coeliac disease.

Cobden, I; Dickinson, Rebecca; Rothwell, J.; Axon, Anthony

doi:10.1136/bmj.2.6144.1060

Cited by 125 publications

(55 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12,18 Reduced mannitol excretion indicates villous atrophy. [19][20][21][22][23] In alcoholic liver disease, villous atrophy is frequently observed; reduction in villous height in relation to crypt depth and lower mucosal surface have been detected by light microscopy in alcoholics, even in the absence of cirrhosis. [24][25][26] Following the introduction of capsule endoscopy, mucosal abnormalities of the small intestine in liver cirrhosis patients with portal hypertension have been well documented and include inflammatory-like abnormalities (oedema, erythema, granularity and friability) as well as vascular lesions (cherry red spots, telangiectasias or angiodysplasia-like lesions and varices).…”

Section: Discussionmentioning

confidence: 99%

Increased intestinal permeability in malnourished patients with liver cirrhosis

Norman

Pirlich

et al. 2012

Eur J Clin Nutr

View full text Add to dashboard Cite

BACKGROUND/OBJECTIVE: Malnutrition is a prominent feature in liver cirrhosis, with deleterious impact on clinical outcome. The objective of this study is to investigate whether malnutrition is associated with increased gastrointestinal permeability in liver cirrhosis reflected by altered urinary excretion of non-metabolizable sugar probes. SUBJECTS/METHODS: Patients with advanced liver cirrhosis (Child Pugh Score B or C) were recruited. Nutritional status was determined according to the Subjective Global Assessment. Intestinal permeability was assessed by measuring the urinary excretion of orally administered, non-metabolized sugar probe molecules. The lactulose/mannitol ratio served as marker for intestinal permeability and reflects non-carrier-mediated transcellular and paracellular transport of the small intestine during the first 5 h. Sucrose recovery in urine within the first 5 h reflects gastroduodenal permeability; sucralose recovery in urine 5-26 h after consumption reflects colonic permeability. RESULTS: Sixty-four patients (56.7±10.8 years; 33% female) were included in the study. Twenty-one patients were considered well nourished according to the Subjective Global Assessment, 23 moderately nourished and 20 patients severely malnourished; 74% had alcoholic liver disease and 67% had cirrhosis stage Child C. Gastroduodenal and colonic permeability was significantly increased in patients with liver cirrhosis compared with 63 healthy controls (0.23±0.22 and 1.37±1.42% vs 0.14±0.10 and 0.41±0.72% in controls), but not different between well and malnourished subjects. Small intestinal permeability (lactulose/ mannitol ratio) was increased in all patients (0.069 ± 0.055%) and further increased in malnourished patients (0.048 ± 0.031% vs 0.084 ± 0.061%, P ¼ 0.004) due to decreased mannitol recovery only. CONCLUSIONS: Gastric, small intestinal and even colonic permeability was altogether increased in liver cirrhosis, and malnutrition was associated with further increased small intestinal permeability indicative of villous atrophy.

show abstract

Section: Discussionmentioning

confidence: 99%

Increased intestinal permeability in malnourished patients with liver cirrhosis

Norman

Pirlich

et al. 2012

Eur J Clin Nutr

View full text Add to dashboard Cite

show abstract

“…Mannitol, a polyhydric alcohol of molecular weight 182 and molecular size 0.4 nm, seems to be pas sively absorbed through small pores in the lipid membrane of the enterocyte which al low passage of such hydrophilic molecules [10]. Mannitol absorption is decreased in sit uations where the villi are shortened, and therefore intestinal surface area is reduced, such as untreated coeliac disease in man [7,9] or in experimental villous damage in rats [10,11]. Therefore, reduced mannitol ab sorption may reflect reduction in absorptive area of the mucosa rather than a change in mucosal 'leakiness'.…”

Section: Discussionmentioning

confidence: 99%

“…The study of small intestinal perme ability by measuring absorption of two nonmetabolised sugars, one of lower and one of higher molecular weight, has been docu mented in coeliac disease [7][8][9]. Mannitol, a polyhydric alcohol of molecular weight 182 and molecular size 0.4 nm, seems to be pas sively absorbed through small pores in the lipid membrane of the enterocyte which al low passage of such hydrophilic molecules [10].…”

Section: Discussionmentioning

confidence: 99%

Abnormal Small Intestinal Permeability to Sugars in Patients with Crohn’s Disease of the Terminal Ileum and Colon

Ukabam

Clamp

Cooper³

1983

Digestion

177

View full text Add to dashboard Cite

The absorption of lactulose and mannitol in 20 patients with Crohn’s disease limited to the ileum or colon was studied, and lactulose/mannitol excretion ratios were calculated. The results were compared to those from 16 normal controls and 6 patients with ulcerative colitis. The 13 patients with ileal Crohn’s disease had significantly higher lactulose/mannitol excretion ratios than the controls (p < 0.01) or ulcerative colitics (p < 0.01). Similarly, the 7 patients with Crohn’s disease limited to the colon had significantly higher excretion ratios than the controls (p < 0.01) or ulcerative colitics (p < 0.01). The results provide support for the concept that Crohn’s disease may be more extensive than is apparent macroscopically.

show abstract

“…Depending on the part of the gastrointestine to be measured, the corresponding disease about 20 years ago [1,2]. In the mean time, permeability tests have replaced all other earlier malabsorption compounds have to be chosen, e.g.…”

Section: Introductionmentioning

confidence: 99%

Changes in Gastrointestinal Permeability in Celiac Disease

Vogelsang¹,

Schwarzenhofer²,

Oberhuber

1998

Dig Dis

View full text Add to dashboard Cite

Increased gastrointestinal permeability was found in celiac disease already 20 years ago. Originally a genetical defect was supposed leading to elevated permeability and later to celiac disease. However, patients under long-term gluten-free diet normalized their permeability tests. On the other side, unaffected relatives of patients with celiac disease showed high permeability but not different from patients with irritable bowel syndrome and with a tendency for normalization during follow-up. In active symptomatic celiac disease, permeability is elevated in the gastroduodenum – measured by sucrose test – as well as in the small intestine – measured by lactulose/mannitol ratio. The sensitivity in active celiac disease is high (near 100%), the specificity is low due to high permeability in many intestinal diseases as in acute infectious gastroenteritis, Crohn’s disease, nonsteroidal anti-inflammatory drug treatment, etc. In contrast, lactulose/mannitol test permeability is much less sensitive in silent celiac disease without diarrhea (74%). The real importance of permeability disease is established by its use for follow-up of celiac patients under gluten-free diet whereas it is correlated to the degree of mucosal atrophy. In vitro tests also show increased lactulose mucosal to serosal flux in celiac disease, but not correlated to oral permeability test. In conclusion, lactulose/mannitol test is the only noninvasive functional test in celiac disease which has essential importance in active celiac disease and in follow-up under diet.

show abstract

Intestinal permeability assessed by excretion ratios of two molecules: results in coeliac disease.

Cited by 125 publications

References 3 publications

Increased intestinal permeability in malnourished patients with liver cirrhosis

Increased intestinal permeability in malnourished patients with liver cirrhosis

Abnormal Small Intestinal Permeability to Sugars in Patients with Crohn’s Disease of the Terminal Ileum and Colon

Changes in Gastrointestinal Permeability in Celiac Disease

Contact Info

Product

Resources

About