Wireless Capsule Endoscopy in Patients with Leaky Gut Syndrome

Abstract

Introduction: Leaky Gut Syndrome (LGS) has been described as a syndrome of increased intestinal permeability. It is associated with a range of disorders including Crohn's disease, celiac disease, chronic fatigue syndrome, and fibromyalgia. The sentinel event in the pathogenesis of this syndrome is postulated to be disruption of mucosal tight junctions between epithelial cells with consequent permeability alteration such that large molecules can cross from the gut lumen across the barrier into the circulation thereby stimulating immune reactivity. At present, the degree of “leakiness” of the intestinal mucosa can be measured using inert, nonmetabolized sugars such as mannitol, rhamnose, or lactulose. One of the most widely available standardized clinical assays, an elevated serum lactulose/mannitol ratio, implies a tendency toward “leaky gut”. Wireless Capsule Endoscopy (CE) has proven utility in diagnosing small bowel disorders including Celiac disease, Crohn's Disease, lymphoma, arteriovenous malformations, and toxic injury. The purpose of this pilot study is to investigate whether patients with LGS have gross mucosal abnormalities that can be demonstrated by CE. Methods: A convenience sample of twelve subjects with laboratory diagnosed LGS were referred to our center for CE. No patient demonstrated any clinical signs or symptoms of inflammatory bowel disease. All patients underwent CE, which was subsequently reviewed in an unblinded fashion by a board-certified gastroenterologist (KFB) with extensive experience in the technique. Results: Mean subject age was 48 (range from 17 to 67) and the male:female ratio was 5:7. No subject demonstrated villous blunting, erosions, or ulcerations. All demonstrated well-preserved circumferential folds and normal peristaltic activity. No erosions or ulcerations were seen. Conclusion: LGS does not appear to be associated with any gross mucosal abnormalities that can be demonstrated by CE. Next-generation innovations including capsules that can both visualize and biopsy small intestine mucosa and “chromocapsule” endoscopic technique may have a better-defined role in evaluating any abnormalities in LGS.