Abstract
BackgroundIntestinal mucosa is leaky in celiac disease (CD), and this alteration may involve changes in hydrophobicity of the mucus surface barrier in addition to alteration of the epithelial barrier. The aims of our study were i) to compare duodenal hydrophobicity as an index of mucus barrier integrity in CD patients studied before (n = 38) and during gluten- free diet (GFD, n = 68), and in control subjects (n = 90), and ii) to check for regional differences of hydrophobicity in the gastro-intestinal tract.MethodsHydrophobicity was assessed by measurement of contact angle (CA) (Rame Hart 100/10 goniometer) generated by a drop of water placed on intestinal mucosal biopsies.ResultsCA (mean ± SD) of distal duodenum was significantly lower in CD patients (56° ± 10°)) than in control subjects (69° ± 9°, p < 0.0001), and persisted abnormal in patients studied during gluten free diet (56° ± 9°; p < 0.005). CA was significantly higher (62° ± 9°) in histologically normal duodenal biopsies than in biopsies with Marsh 1-2 (58° ± 10°; p < 0.02) and Marsh 3 lesions (57° ± 10°; p < 0.02) in pooled results of all patients and controls studied. The order of hydrofobicity along the gastrointestinal tract in control subjects follows the pattern: gastric antrum > corpus > rectum > duodenum > oesophagus > ileum.ConclusionsWe conclude that the hydrophobicity of duodenal mucous layer is reduced in CD patients, and that the resulting decreased capacity to repel luminal contents may contribute to the increased intestinal permeability of CD. This alteration mirrors the severity of the mucosal lesions and is not completely reverted by gluten-free diet. Intestinal hydrophobicity exhibits regional differences in the human intestinal tract.
Highlights
Intestinal mucosa is leaky in celiac disease (CD), and this alteration may involve changes in hydrophobicity of the mucus surface barrier in addition to alteration of the epithelial barrier
The aim of our study was to assess the hyfrophobicity of the mucus barrier by measuring contact angle of gastro-intestinal mucosa exposed to a drop of saline in CD patients at diagnosis, and to assess the effect of gluten free diet (GFD)
Our study clearly indicates that the mucus barrier is altered in CD, and that this defect is not restored to normal during GFD as indicated by the observation that hdyrophobicity of duodenal mucosa is lower in CD patients than in control subjects, and that this abnormality persists during GFD
Summary
Intestinal mucosa is leaky in celiac disease (CD), and this alteration may involve changes in hydrophobicity of the mucus surface barrier in addition to alteration of the epithelial barrier. The intestinal barrier is altered in several diseases including celiac disease (CD) [5] an autoimmune disease that develops in genetically predisposed subjects exposed to ingestion of wheat gliadin and of related prolamines of barley and rye This alteration of the intestinal barrier of CD results in increased intestinal permeability [6], a phenomenon attributed to excess production of a local peptide, zonulin, leading to disassembly of the tight junction structure that in physiological conditions seals the barrier and limits the paracellular passage of macromolecules, including the toxic fractions of gliadin [7]. The importance of this characteristic in contributing to the integrity of the intestinal barrier is supported by the finding that decreased hydrophobicity has been documented in a variety of conditions including peptic ulcer disease [11], Helicobacter pylori infection and gastritis [12], and to accompany damage to the stomach or colon caused by non steroidal anti-inflammatory drugs [13], 2,4,6-trinitrobenzenesulphoric acid [14], LPS [15] or dextran sodium sulphate [16]
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