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Intestinal permeability tests in coeliac disease.
Clin Lab 2001; 47(3-4):143-50CL

Abstract

Intestinal permeability tests have been used to screen for a wide range of small intestinal diseases, including coeliac disease and enteric infections. Several probe molecules have been used to investigate intestinal permeability including monosaccharides, disaccharides, 51Cr-EDTA and polyethyleneglycol. While many factors may affect intestinal permeability tests, the use of two probe molecules, for example, lactulose and mannitol, and the expression of the result as a ratio minimises the effects of these extraneous factors. Rendering the test solution hyperosmolar was also found to increase the sensitivity of the test in detecting coeliac disease. Intestinal permeability is characteristically elevated in untreated coeliac disease, with a sensitivity of up to 96% for the dual sugar techniques. The reason for this is a consistent increase in the absorption of lactulose (via the paracellular route) due to increased "leakiness" of the intestine and a reduction in the absorption of mannitol (via the transcellular route) due to a reduction in surface area as a result of villous atrophy. The intestinal permeability test allows subjects to be selected for jejunal biopsy in whom the clinical features are compatible with coeliac disease and in timing a follow-up biopsy. It has been postulated that raised intestinal permeability may be involved in the pathogenesis of coeliac disease. Recently, serum measurements of the probe molecules may have a valuable role, particularly in paediatric patients. Sucrose permeability has also been proposed as an accurate marker of adult coeliac disease and shows promise as a noninvasive test.

Authors+Show Affiliations

Department of Gastroenterology, Belfast City Hospital, Northern Ireland. sjohnston@potblack.thegap.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

11294577

Citation

Johnston, S D., et al. "Intestinal Permeability Tests in Coeliac Disease." Clinical Laboratory, vol. 47, no. 3-4, 2001, pp. 143-50.
Johnston SD, Smye M, Watson RP. Intestinal permeability tests in coeliac disease. Clin Lab. 2001;47(3-4):143-50.
Johnston, S. D., Smye, M., & Watson, R. P. (2001). Intestinal permeability tests in coeliac disease. Clinical Laboratory, 47(3-4), pp. 143-50.
Johnston SD, Smye M, Watson RP. Intestinal Permeability Tests in Coeliac Disease. Clin Lab. 2001;47(3-4):143-50. PubMed PMID: 11294577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intestinal permeability tests in coeliac disease. AU - Johnston,S D, AU - Smye,M, AU - Watson,R P, PY - 2001/4/11/pubmed PY - 2001/9/28/medline PY - 2001/4/11/entrez SP - 143 EP - 50 JF - Clinical laboratory JO - Clin. Lab. VL - 47 IS - 3-4 N2 - Intestinal permeability tests have been used to screen for a wide range of small intestinal diseases, including coeliac disease and enteric infections. Several probe molecules have been used to investigate intestinal permeability including monosaccharides, disaccharides, 51Cr-EDTA and polyethyleneglycol. While many factors may affect intestinal permeability tests, the use of two probe molecules, for example, lactulose and mannitol, and the expression of the result as a ratio minimises the effects of these extraneous factors. Rendering the test solution hyperosmolar was also found to increase the sensitivity of the test in detecting coeliac disease. Intestinal permeability is characteristically elevated in untreated coeliac disease, with a sensitivity of up to 96% for the dual sugar techniques. The reason for this is a consistent increase in the absorption of lactulose (via the paracellular route) due to increased "leakiness" of the intestine and a reduction in the absorption of mannitol (via the transcellular route) due to a reduction in surface area as a result of villous atrophy. The intestinal permeability test allows subjects to be selected for jejunal biopsy in whom the clinical features are compatible with coeliac disease and in timing a follow-up biopsy. It has been postulated that raised intestinal permeability may be involved in the pathogenesis of coeliac disease. Recently, serum measurements of the probe molecules may have a valuable role, particularly in paediatric patients. Sucrose permeability has also been proposed as an accurate marker of adult coeliac disease and shows promise as a noninvasive test. SN - 1433-6510 UR - https://www.unboundmedicine.com/medline/citation/11294577/Intestinal_permeability_tests_in_coeliac_disease_ L2 - https://medlineplus.gov/celiacdisease.html DB - PRIME DP - Unbound Medicine ER -