Is the sugar intestinal permeability test a reliable investigation for coeliac disease screening?

Catassi, Carlo; Fabiani, Elisabetta; Rätsch, I M; Bonucci, Alessandro; Dotti, M. T.; Coppa, G V; Giorgi, Pier Luigi

doi:10.1136/gut.40.2.215

Cited by 24 publications

(11 citation statements)

References 11 publications

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“…results]. Comparable results with low sensitivity (45%) of lactulose/mannitol test in celiac patients found by screening have recently been published [12].…”

Section: Introductionsupporting

confidence: 52%

Changes in Gastrointestinal Permeability in Celiac Disease

Vogelsang¹,

Schwarzenhofer²,

Oberhuber

1998

Dig Dis

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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.

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“…results]. Comparable results with low sensitivity (45%) of lactulose/mannitol test in celiac patients found by screening have recently been published [12].…”

Section: Introductionsupporting

confidence: 52%

Changes in Gastrointestinal Permeability in Celiac Disease

Vogelsang¹,

Schwarzenhofer²,

Oberhuber

1998

Dig Dis

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“…Noninvasive measurements using orally administered sugar probes (lactulose, mannitol, and sucrose) were used to determine gastrointestinal permeability at diagnosis and after one year on the GFD [ 15 – 18 ]. Urine samples were also collected from healthy individuals with no gastrointestinal symptoms or family history of CD [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Rajani

Huynh

Shirton

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n = 40) and ED (n = 48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034; p = 0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092; p = 0.44), or fecal calprotectin (FC; 89.6 versus 51.4; p = 0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p = 0.55) and %FES (0.040 versus 0.047; p = 0.87) (p > 0.05). FC improved but remained higher in the SD group (37.1 versus 15.9; p = 0.04). Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.

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“…Permeability: Permeation of the intestine to larger probes such as lactulose increases, and permeation of small monosaccharides such as mannitol decreases, in celiac disease patients. An increased urinary lactulose to mannitol excretion ratio is common in persons with celiac disease, although some workers have found the lactulose to mannitol ratio to be abnormal in less than two-thirds of such individuals (161). This suggests that the sugar intestinal permeability test may have a limited role in diagnosing celiac disease, particularly in individuals who have no symptoms.…”

Section: Clinical Learning Pointmentioning

confidence: 99%