Gut permeability to lactulose and mannitol differs in treated Crohn's disease and celiac disease patients and healthy subjects

E.G Vilela,M.L.A Ferrari,A.S Lima,H.O.G Torres,A.S Cunha

doi:10.1590/s0100-879x2008001200010

E.G Vilela, M.L.A Ferrari + Show 3 more

Open Access

https://doi.org/10.1590/s0100-879x2008001200010

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Abstract

The gut barrier monitors and protects the gastrointestinal tract from challenges such as microorganisms, toxins and proteins that could act as antigens. There is evidence that gut barrier dysfunction may act as a primary disease mechanism in intestinal disorders. The aim of the present study was to evaluate the barrier function towards sugars after the appropriate treatment of celiac disease and Crohn's disease patients and compare the results with those obtained with healthy subjects. Fifteen healthy volunteers, 22 celiac disease patients after 1 year of a gluten-free diet, and 31 Crohn's disease patients in remission were submitted to an intestinal permeability test with 6.0 g lactulose and 3.0 g mannitol. Six-hour urinary lactulose excretion in Crohn's disease patients was significantly higher than in both celiac disease patients (0.42 vs 0.15%) and healthy controls (0.42 vs 0.07%). Urinary lactulose excretion was significantly higher in celiac disease patients than in healthy controls (0.15 vs 0.07%). Urinary mannitol excretion in Crohn's disease patients was the same as healthy controls (21 vs 21%) and these values were significantly higher than in celiac disease patients (10.9%). The lactulose/mannitol ratio was significantly higher in Crohn's disease patients in comparison to celiac disease patients (0.021 vs 0.013) and healthy controls (0.021 vs 0.003) and this ratio was also significantly higher in celiac disease patients compared to healthy controls (0.013 vs 0.003). In spite of treatment, differences in sugar permeability were observed in both disease groups. These differences in the behavior of the sugar probes probably reflect different mechanisms for the alterations of intestinal permeability.

Highlights

The gastrointestinal tract is the primary organ of digestion and absorption, but it constitutes the largest area of exposure to the outside environment in the human body
Urinary lactulose excretion in Crohn’s disease patients was significantly higher than in both celiac disease patients (0.42 vs 0.15%, P = 0.001) and healthy controls (0.42 vs 0.07%, P = 0.0001)
The non-invasive functional intestinal permeability test is extremely important for both triage of active celiac disease, as well as for monitoring celiac patients on a glutenfree diet [8,9,10]

Summary

Introduction

The gastrointestinal tract is the primary organ of digestion and absorption, but it constitutes the largest area of exposure to the outside environment in the human body. The function known as gut barrier is related to the integrity of the gastrointestinal tract and, at the same time, to the relationship between the microbiota of the intestinal lumen and the host. The concept of gut barrier is associated with permeability and is related to the property of a membrane that enables the passage of a solute by unmediated diffusion. The development of methods for assessing intestinal barrier function became feasible after the introduction of non-metabolizable oligosaccharides as test substances in the 1970’s [2]. The oral administration of sugars and the subsequent measurement of these substances in the urine, denoted the intestinal permeability test, is a non-invasive method that has been used for the assessment of the integrity of the epithelial barrier

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