Intestinal Permeability in Children with Celiac Disease after the Administration of Oligofructose-Enriched Inulin into a Gluten-Free Diet—Results of a Randomized, Placebo-Controlled, Pilot Trial

Abstract

Abnormalities in the intestinal barrier are a possible cause of celiac disease (CD) development. In animal studies, the positive effect of prebiotics on the improvement of gut barrier parameters has been observed, but the results of human studies to date remain inconsistent. Therefore, this study aimed to evaluate the effect of twelve-week supplementation of a gluten-free diet (GFD) with prebiotic oligofructose-enriched inulin (10 g per day) on the intestinal permeability in children with CD treated with a GFD. A pilot, randomized, placebo-controlled nutritional intervention was conducted in 34 children with CD, being on a strict GFD. Sugar absorption test (SAT) and the concentrations of intestinal permeability markers, such as zonulin, intestinal fatty acid-binding protein, claudin-3, calprotectin, and glucagon-like peptide-2, were measured. We found that the supplementation with prebiotic did not have a substantial effect on barrier integrity. Prebiotic intake increased excretion of mannitol, which may suggest an increase in the epithelial surface. Most children in our study seem to have normal values for intestinal permeability tests before the intervention. For individuals with elevated values, improvement in calprotectin and SAT was observed after the prebiotic intake. This preliminary study suggests that prebiotics may have an impact on the intestinal barrier, but it requires confirmation in studies with more subjects with ongoing leaky gut.

Leaky Gut: Effect of Dietary Fiber and Fats on Microbiome and Intestinal Barrier

“…These results also suggest that MACs have beneficial effects on the intestinal barrier. Nevertheless, whether MAC supplementation is really recommended to maintain intestinal health including barrier function is not confirmed yet since some clinical studies show beneficial effects of fructo-oligosaccharides and polydextrose on intestinal barrier function in healthy subjects or patients of pancreatitis [ 82 , 83 ], but administration of oat β-glucan, arabinoxylan (soluble hemicellulose) do not show significant effects on acute indomethacin-induced intestinal hyperpermeability [ 84 , 85 ]. Oligofructose-enriched inulin also does not improve intestinal barrier function effective in the patients of celiac disease [ 84 , 85 ].…”

Probiotics, Prebiotics and Other Dietary Supplements for Gut Microbiota Modulation in Celiac Disease Patients

“…Prebiotics are defined according to the International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement as a substrate that is selectively utilized by host microorganisms conferring a health benefit [72]. Among the new therapies recently proposed, prebiotics are a promising and safe additive to GFD with a beneficial influence on human health [73]. Prebiotics have the power to stimulate the growth and activity of potentially health-promoting bacteria strains in the intestine, mainly Bifidobacterium and Lactobacillus.…”

“…For this reason, their ability to regulate the activity of gut microbiota could be used to address CD-related symptoms. Literature data lead to the hypothesis that the inclusion of prebiotics in GFD could also be easy to administer and cost-effective as an adjunctive treatment for CD [73]. Only a few pilot human studies have been carried out to clarify the impact of prebiotics on the intestinal inflammation in general and, in particular, on CD [43,56]; most of them include formulations of prebiotics combined with other ingredients.…”

Pediatric Celiac Disease Patients Show Alterations of Dendritic Cell Shape and Actin Rearrangement

“…An increase in intestinal permeability resulting from a loss of the barrier function due to tissue damage is a constant feature in CD subjects [ 32 ]. GFD can partially or fully restore these alterations [ 11 , 33 ].…”