Intestinal permeability is increased in patients with intermittent claudication.
OBJECTIVE
Intermittent claudication can be regarded as repeated ischemia reperfusion injury, which can induce a generalized increase in vascular permeability, including in intestine. The lactulose mannitol test (L/M test) was performed in patients with intermittent claudication to evaluate the change in intestinal permeability when they were forced to walk.


METHODS
The L/M test was performed in 11 patients with intermittent claudication and 11 control subjects without intermittent claudication. The test was performed at rest and after exercise. Patients walked on a treadmill until they stopped because of pain. The control subjects were forced to walk as far as 200 m on a treadmill. The L/M test was repeated in the patients after successful arterial reconstruction. Then the patients were instructed to walk the same distance at the same speed as they had before surgery.


RESULTS
In patients, the mean L/M ratio after exercise was significantly higher than the mean L/M ratio when they were at rest (0.068 +/- 0.053 vs 0.022 +/- 0.009, P <.05). In control subjects, however, no significant difference was observed between the mean L/M ratios after exercise and at rest. The mean L/M ratio after exercise, decreased from 0.068 +/- 0.053 to 0.018 +/- 0. 016 after successful arterial reconstruction (P <.05) in patients.


CONCLUSIONS
Intestinal permeability, determined by means of the L/M test, significantly increased in patients with intermittent claudication after exercise, and it diminished after arterial reconstruction. The L/M test is, consequently, a new noninvasive method to reflect ischemia in lower limbs during exercise.
Iwata
H
H
First Department of Surgery, Nagoya University School of Medicine, Japan.
Matsushita
M
M
Nishikimi
N
N
Sakurai
T
T
Nimura
Y
Y
D000368:Aged; D016022:Case-Control Studies; D004234:Diuretics, Osmotic; D005080:Exercise Test; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology*; D007422:Intestines / Q000502:physiology*; D007792:Lactulose; D008297:Male; D008353:Mannitol; D010539:Permeability
D004234:Diuretics, Osmotic; D005765:Gastrointestinal Agents; D008353:Mannitol; D007792:Lactulose