Small bowel intestinal permeability in Australian aboriginal children.
OBJECTIVE
To show that the severity of diarrheal disease in Aboriginal children in tropical Australia is a consequence of underlying small intestinal mucosal damage.


METHODS
A prospective study of 338 Aboriginal admissions compared to 37 non-Aboriginal children, both diarrhea cases and controls. Intestinal permeability was measured by lactulose-rhamnose (L/R) ratios on a timed 90-minute blood test.


RESULTS
For diarrheal admissions, significantly more Aboriginal (vs. non-Aboriginal children) had hypokalemia (70 vs. 10%), acidosis (65 vs. 29%), moderate to severe dehydration (52 vs. 19%) and a longer mean length of stay (mean 8.9 vs. 3.9 days). Mean L/R ratios (95% confidence intervals) in Aboriginal children (diarrhea vs. controls) were 16.5 (14.6-18.7) vs. 4.5 (3.8-5.3) compared to 7.7 (4.4-13.3) vs. 2.5 (1.8-3.4), respectively, in non-Aboriginals. Abnormal permeability ratios (> 5.6) consistent with tropical-environmental enteropathy syndrome were found in 36% (27/75) of Aboriginal controls compared to none of the non-Aboriginal controls. On multiple regression, the factors associated with high L/R ratios were diarrheal severity ( < 0.001), acidosis ( = 0.007) and hypokalemia ( = 0.04).


CONCLUSIONS
An underlying tropical-environmental enteropathy contributes to the severity of acute gastroenteritis in Aboriginal children. Diarrheal complications, such as acidosis, hypokalemia, and osmotic diarrhea are associated with high L/R ratios, reflecting greater small intestinal mucosal damage.
Kukuruzovic
Renata H
RH
NT Clinical School, Flinders University and Paediatric Department, Royal Darwin Hospital, Darwin, Nothern Territory, Australia.
Brewster
David R
DR
D000138:Acidosis / Q000208:ethnology / Q000209:etiology; D002675:Child, Preschool; D003681:Dehydration / Q000209:etiology; D003967:Diarrhea / Q000208:ethnology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000209:etiology; D007223:Infant; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000378:metabolism*; D007792:Lactulose / Q000493:pharmacokinetics*; D007902:Length of Stay; D008297:Male; D015876:Northern Territory; D010539:Permeability; D011446:Prospective Studies; D012210:Rhamnose / Q000493:pharmacokinetics*; D012720:Severity of Illness Index
D007792:Lactulose; D012210:Rhamnose