Sensitivity of a hyperosmolar or "low"-osmolar test solution for sugar absorption in recognizing small intestinal mucosal damage in coeliac disease.
Reliability of differential sugar absorption tests is hampered by a lack of standardization of the content and osmolarity of the test solutions. We evaluated the effect of osmolarity of the test solution of the sugar absorption test on the 5 hour urine excretion of orally administered lactulose and mannitol. A group of 28 controls and 14 coeliacs, with villous atrophy grade II to IV, ingested a hyperosmolar sugar absorption test solution and a "low"-osmolar solution, respectively. After an overnight fast, each subject ingested hyperosmolar sugar absorption test solution (2 g mannitol, 5 g lactulose and 40 g sucrose/100 ml (around 1,560 mmol/l)). After two days, this procedure was repeated with low-osmolar solution (2 g mannitol and 5 g lactulose/100 ml (around 375 mmol/l). The influence of the sequence of the tests on the results had previously been excluded. All urine from the 5 h-period following ingestion of the test solution was collected. To calculate the low-osmolar solution ratio, samples were analysed for lactulose and mannitol concentrations by gas chromatography The sensitivity of hyperosmolar SAT solution and low-osmolar solution for the detection of mucosal abnormalities in coeliacs was 64% and 43%, respectively. In conclusion, a hyperosmolar solution discriminates better between normal and damaged mucosa of the small bowel such as villous atrophy due to a relative increase in permeability for lactulose.
Uil
J J
JJ
Department of Gastroenterology, University Hospital, Utrecht, The Netherlands.
van Elburg
R M
RM
Janssens
P M
PM
Mulder
C J
CJ
Heymans
H S
HS
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001706:Biopsy; D050260:Carbohydrate Metabolism; D002446:Celiac Disease / Q000175:diagnosis / Q000652:urine*; D003938:Diagnostic Techniques, Digestive System; D004234:Diuretics, Osmotic / Q000008:administration & dosage / Q000493:pharmacokinetics; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology*; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000473:pathology; D007421:Intestine, Small; D007792:Lactulose / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008875:Middle Aged; D009994:Osmolar Concentration; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013395:Sucrose / Q000008:administration & dosage / Q000493:pharmacokinetics*
D004234:Diuretics, Osmotic; D005765:Gastrointestinal Agents; D008353:Mannitol; D007792:Lactulose; D013395:Sucrose