Follow-up of treated coeliac patients: sugar absorption test and intestinal biopsies compared.
OBJECTIVE
To determine whether the sugar absorption test (SAT) during follow-up of patients with coeliac disease on a gluten-free diet (GFD) correlates with improvement of the villous architecture of the small intestine.


METHODS
The SAT was performed in coeliacs at diagnosis and during follow-up with GFD. For the SAT, a solution of lactulose (L) and mannitol (M) was given to the fasting patient and the L-M ratio calculated in a 5-hour urine sample by gas chromatography: ratios > 0.089 are considered abnormal. The solution was made hyperosmolar by adding sucrose (1560 mmol/l).


RESULTS
The L-M ratio was 2-3 times higher at diagnosis than either at 8 months to 2 years gluten free, or beyond 2 years gluten free, consecutively. The L-M ratio (mean, range) was significantly higher in cases of biopsies with (sub)total villous atrophy (VA) (0.388, 0.062-0.804, n = 28), partial VA (0.240, 0.062-0.841, n = 18) and villous irregularity (0.143, 0.017-0.322, n = 29) than in case of normalized histology after GFD (0.085, 0.021-0.230, n = 19). The rate of normalization of functional integrity was slower in adults than in children, demonstrated by a combination of histology and SAT.


CONCLUSIONS
The SAT correlates well with the degree of VA. It is important for daily clinical practice that the simple and non-invasive SAT can be used as an indicator of intestinal damage, thus influencing need for and timing of intestinal biopsies.
Uil
J J
JJ
Department of Hepatogastroenterology, University Hospital Utrecht, The Netherlands.
van Elburg
R M
RM
van Overbeek
F M
FM
Meyer
J W
JW
Mulder
C J
CJ
Heymans
H S
HS
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy* / Q000378:metabolism / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002849:Chromatography, Gas; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000493:pharmacokinetics* / Q000652:urine; D005983:Glutens; D006801:Humans; D007223:Infant; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology; D007421:Intestine, Small / Q000378:metabolism* / Q000473:pathology; D007792:Lactulose / Q000493:pharmacokinetics* / Q000652:urine; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics* / Q000652:urine; D008875:Middle Aged; D009994:Osmolar Concentration; D013395:Sucrose / Q000493:pharmacokinetics
D005765:Gastrointestinal Agents; D008353:Mannitol; D007792:Lactulose; D013395:Sucrose; D005983:Glutens