Intestinal permeability in the newborn

Passive intestinal permeability in 33 newborn babies was studied using feeds containing lactulose and mannitol. Each marker is thought to pass across the gut wall by a different route; lactulose by a paracellular and mannitol by a transcellular pathway. Neither is metabolised and both are wholly and solely excreted by the kidney; urinary recovery is a measure of the intestinal uptake. Babies born before 34 weeks' gestation exhibited a higher intestinal permeability to lactulose than more mature babies, and all preterm babies showed an appreciable decline in lactulose absorption during the first week of oral feeds. Babies of 34 to 37 weeks' gestation achieved a 'mature' intestinal permeability to lactulose within four days of starting oral feeds. These findings may reflect the immaturity of the gut of the preterm baby rather than a process essential to adaptation to enteral nutrition.     

Intestinal permeability in Crohn's disease.

Crohn''s disease may present insidiously, especially in childhood, and diagnosis may be delayed. In addition, the clinical assessment of the extent of disease activity may be inaccurate. Using mannitol and lactulose as probe molecules we have carried out a cross sectional study of intestinal permeability in patients with active Crohn''s disease (n = 17) and control subjects (n = 31). Activity was assessed by an activity index score. The lactulose:mannitol urinary excretion ratio was significantly increased in Crohn''s disease. Overall sensitivity was 82%, and 92% when activity was moderate or severe. When permeability was compared with the activity index there was a significant correlation among patients. In five patients studied longitudinally a significant correlation was also present. Measurement of intestinal permeability is non-invasive, and may be useful both as a screening test in patients with non-specific symptoms, and for the assessment of the extent of disease activity in patients with Crohn''s disease.     

Intestinal permeability in different feedings in infancy

AIM: To determine the intestinal permeability (IP) as a marker of intestinal epithelial integrity in formula-fed infants compared with healthy breast-fed infants. METHODS: IP was measured in 57 healthy infants less than 4 months old. A dual sugar test with lactulose and mannitol was performed. Three urinary ratios were established: lactulose/mannitol (L/M), lactulose/creatinine (L/C) and mannitol/creatinine (M/C). Five groups were studied: breast-fed (n = 11), prebiotic supplemented formula (n 17), nucleotides supplemented formula (n = 9), LC-PUFA supplemented formula (n = 9) and LC-PUFA and nucleotides supplemented formula (n = 11). RESULTS: We have not found any difference in IP between breast-fed and formula-fed infants nor when the different formulas are compared with each other. The indirect information of the paracellular pathway by the ratio L/C and the transcellular route by the ratio M/C reflects some difference when the ingredients added are fructooligosaccharides and galactooligosaccharides, expressing a higher degree of lactulose permeation with respect to mannitol. When LC-PUFA supplementation was evaluated a lesser ratio of L/C was found, expressing intestinal barrier related to a process of epithelial tight. CONCLUSIONS: The most important factor in the maintenance of the integrity of epithelial barrier function is probably the delivery of nutrients in the gastrointestinal tract. The role of the different ingredients added should be clarified.     

Intestinal permeability is increased in bronchial asthma

Background: Increased intestinal permeability has been reported in one study of adult asthmatics. Aim: To determine whether children with asthma have altered intestinal permeability. Methods: Thirty two asthmatic children, and 32 sex and age matched controls were recruited. The dual sugar (lactulose and mannitol) test was used to evaluate intestinal permeability, and the percentage of ingested lactulose (L) and mannitol (M) in the urine, and the L:M ratio were determined. All patients were skin prick tested for common aeroallergens, and specific IgE to some food items was determined. Results: The median value of L in asthmatic children (2.29, IQR 0.91–4.07) was significantly higher than that in controls (0.69, IQR 0.45–1.08), and that of M was almost similar. The ratio L:M was significantly higher in asthmatic children (0.20, IQR 0.11–0.40) than in controls (0.06, IQR 0.04–0.09). Intestinal permeability did not correlate with eczema, inhaled steroids, positive skin prick test to aeroallergens, or severity of asthma. Conclusions: Intestinal permeability is increased in children with asthma, suggesting that the whole mucosal system may be affected.     

Intestinal permeability is increased in bronchial asthma.

BACKGROUND: Increased intestinal permeability has been reported in one study of adult asthmatics. AIM: To determine whether children with asthma have altered intestinal permeability. METHODS: Thirty two asthmatic children, and 32 sex and age matched controls were recruited. The dual sugar (lactulose and mannitol) test was used to evaluate intestinal permeability, and the percentage of ingested lactulose (L) and mannitol (M) in the urine, and the L:M ratio were determined. All patients were skin prick tested for common aeroallergens, and specific IgE to some food items was determined. RESULTS: The median value of L in asthmatic children (2.29, IQR 0.91-4.07) was significantly higher than that in controls (0.69, IQR 0.45-1.08), and that of M was almost similar. The ratio L:M was significantly higher in asthmatic children (0.20, IQR 0.11-0.40) than in controls (0.06, IQR 0.04-0.09). Intestinal permeability did not correlate with eczema, inhaled steroids, positive skin prick test to aeroallergens, or severity of asthma. CONCLUSIONS: Intestinal permeability is increased in children with asthma, suggesting that the whole mucosal system may be affected.     

Intestinal permeability during chemotherapy for childhood tumours

The intestinal permeability to mannitol and lactulose was measured in 29 children receiving treatment for solid tumours. At the time of study they had no gastrointestinal symptoms and appeared clinically well. However, there was a significant reduction in the absorption of mannitol when compared to normal children. This small bowel dysfunction may result in malabsorption of nutrients and drugs. There was a significant correlation between decreased mannitol absorption and low nutritional status.     

Intestinal permeability to intact lactose in newborns and adults

Small amounts of lactose have been shown to be absorbed intact across the intestine and excreted unchanged in the urine of newborns and adults. We designed a study to quantitate the intestinal uptake and urinary excretion of this disaccharide in these age groups. Similar amounts of lactose were given orally to 17 term newborns (age: 24.8 +/- 3.0 h) as a standard infant formula, and to 15 adult lactose absorbers (age: 28.1 +/- 2.6 years) and 11 adult lactose malabsorbers (age: 24.7 +/- 2.9 years) as a 20% water solution. Following lactose ingestion, breath was collected every 30 or 60 min for 3 h and analyzed for hydrogen concentration. Urine was also collected, and lactose and creatinine concentrations were determined. Peak hydrogen concentration was less than 20 ppm above baseline in newborns and adult lactose absorbers and 85 +/- 14 ppm in adult lactose malabsorbers. Urinary lactose excretion, expressed as a function of body weight (mg/ml/kg b.w.), was substantially greater in newborns (4.2 +/- 0.82) than in adult lactose absorbers (0.29 +/- 0.07; p less than 0.001) and adult lactose malabsorbers (0.55 +/- 0.04; p less than 0.01). Similarly, urinary lactose excretion expressed as a ratio of urinary lactose to urinary creatinine (mg/mg) was increased (p less than 0.001) in newborns (2.05 +/- 0.26) when compared to adult lactose absorbers (0.11 +/- 0.02) and adult lactose malabsorbers (0.20 +/- 0.02). Our data demonstrate that the intestinal uptake and urinary excretion of intact lactose is significantly increased in newborns compared to adult subjects.     

Macrophage function in kwashiorkor

Serum opsonic activity of heat inactivated plasma of 6 children suffering from kwashiorkor was assayed and compared with that of 6 control children. The function of macrophages per se and the opsonic activity mostly contributed by antibodies were found to be unaltered in kwas hiorkor.     

The colon in kwashiorkor

The colon in kwashiorkor was investigated by means of rectal biopsy and sigmoidoscopy in 20 children, followed by barium enema in 10 of the children. The colon during the acute phase of the disease showed a surface epithelial atrophy, with infiltration of plasma cells and congestion of small vessels. Viewed under the dissecting microscope, a disorganized vascular pattern was seen in all cases.On recovery from kwashiorkor after 3 to 4 weeks, the abnormal vascular pattern and epithelial atrophy of the colon had returned to normal in most children.     

Finger nail clubbing in kwashiorkor

Summary The association of finger nail clubbing and kwashiorkor was investigated in 60 children. Clubbing was present in 46 (76.7%). Since diarrhoea was a prominent feature in all positive patients, a suggestion is put forth that the mild to moderate finger-nail clubbing present in kwashiorkor in this series may be due to a non-specific infection of the gut and may be explained on the basis of the vagal ennervation theory. From the Department of Pediatrics, Cheluvamba Hospital and Medical College, Mysore.