Assessment of the intestinal permeability following postoperative chemotherapy for human malignant disease.
OBJECTIVE
Administration of anticancer drugs may damage gastrointestinal epithelium, thereby increasing the permeability of the gastrointestinal mucosa. We estimated the usefulness of oral lactulose and mannitol (L/M) test for assessment the extent of mucosal damage following postoperative chemotherapy for human malignant disease.


METHODS
The permeability index (PI): the urinary recovery ratio of excreted L to M was measured before and after chemotherapy in 31 patients with gastrointestinal cancers who underwent surgical resection. These findings were compared with data on 12 patients with breast cancer. The effect of chemotherapy was evaluated by the ratio of increase in PI, which was designed as post-chemotherapy value on day 7 divided by pre-chemotherapy value.


RESULTS
The mean PIs before chemotherapy in patients who underwent gastrectomy or colectomy were significantly higher than the value in those treated with mastectomy (p < 0.05). In the gastrointestinal cancer patients, the mean PIs significantly increased after chemotherapy compared with the pre-chemotherapeutic value (p < 0.01), however no significant difference was seen in breast cancer patients. When the ratios of increase in PI were calculated among gastric cancer patients, the total gastrectomy group showed a significantly higher increase in PI compared with the partial gastrectomy group (p < 0.05).


CONCLUSIONS
Since the oral L/M absorption test is useful for assessing the degree of mucosal damage and measurement of intestinal permeability, this analysis should be recommended to determine the optimum timing and the adequate dosage of the anticancer drug administration.
Inutsuka
S
S
Department of General Surgery, Fukuoka Dental College Hospital, Fukuoka, Japan. sada@college.fdcnet.ac.jp
Takesue
F
F
Yasuda
M
M
Honda
M
M
Nagahama
S
S
Kusumoto
H
H
Nozoe
T
T
Korenaga
D
D
D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D002166:Camptothecin / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D008727:Methotrexate / Q000627:therapeutic use; D010539:Permeability / Q000187:drug effects; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery
D000972:Antineoplastic Agents, Phytogenic; D003520:Cyclophosphamide; D002945:Cisplatin; D005472:Fluorouracil; D002166:Camptothecin; D008727:Methotrexate