title: Assessment of hypolactasia and site-specific intestinal permeability by differential sugar absorption of raffinose, lactose, sucrose and mannitol.
abstract: The sugar absorption test is a non-invasive test for investigating intestinal permeability by simultaneous measurement of four probe sugars. In this study, we evaluated the utility of raffinose, lactose, sucrose and mannitol as probe sugars and calculated their urinary recovery as a percentage of ingested dose (mol/mol) and the recovery ratios of raffinose/mannitol, lactose/ raffinose and sucrose/raffinose. The reference ranges for these ratios, established from 39 healthy volunteers, are 0.005-0.015, 0.13-0.63 and 0.09-0.47, respectively. This sugar absorption test was performed in three patient groups. i) In 109 patients with aspecific gastrointestinal symptoms of whom intestinal histology was studied by duodenal biopsies: the urinary raffinose/mannitol recovery ratio highly correlated with gradation of duodenal damage; the sensitivity and specificity of the raffinose/mannitol ratio for detection of intestinal damage were 93% and 91%, respectively, using a cut-off level of 0.020. ii) In 70 patients in whom intestinal lactase activity was investigated by the lactose tolerance test: the urinary lactose/raffinose recovery ratio provided high diagnostic accuracy for hypolactasia (sensitivity 81% and specificity 89% at a cut-off level of 0.70). In analogy with the lactose/raffinose ratio, we suppose that the sucrose/raffinose ratio can be used as a marker of hyposucrasia. iii) In 40 patients with localized small intestinal damage, Crohn's disease of the ileum (n = 21) and celiac disease with histologically proven duodenal damage (n = 19): the raffinose/mannitol recovery ratio was increased in 100% of patients with celiac disease and in 81% of patients with Crohn's disease; increased lactose/raffinose recovery ratio (hypolactasia) and increased sucrose/raffinose (hyposucrasia) were present in 89% and 95% of celiac patients and 19% and 0% of Crohn's disease patients, respectively. The combination of the raffinose/mannitol ratio and sucrose/raffinose ratio appears to be an indication of the distribution of intestinal damage.
authors.affiliation: Clinical Laboratory, Twenteborg Hospital, Almelo, The Netherlands. famjhessels@hetnet.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Hessels
authors.forename: Harry H M
authors.initials: HH
authors.lastname: Eidhof
authors.forename: Jan
authors.initials: J
authors.lastname: Steggink
authors.forename: Wilfried W H
authors.initials: WW
authors.lastname: Roeloffzen
authors.forename: Kalung
authors.initials: K
authors.lastname: Wu
authors.forename: Guy
authors.initials: G
authors.lastname: Tan
authors.forename: Jan
authors.initials: J
authors.lastname: van de Stadt
authors.forename: Leo
authors.initials: L
authors.lastname: van Bergeijk
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001786:Blood Glucose / Q000032:analysis; D002241:Carbohydrates / Q000493:pharmacokinetics* / Q000652:urine; D002446:Celiac Disease / Q000378:metabolism / Q000503:physiopathology; D003424:Crohn Disease / Q000378:metabolism / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D004384:Duodenoscopy; D005260:Female; D005767:Gastrointestinal Diseases / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology*; D007413:Intestinal Mucosa / Q000378:metabolism; D007785:Lactose / Q000493:pharmacokinetics / Q000652:urine; D007787:Lactose Intolerance / Q000175:diagnosis*; D007789:Lactose Tolerance Test / Q000379:methods; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics / Q000652:urine; D008875:Middle Aged; D012372:ROC Curve; D011887:Raffinose / Q000494:pharmacology / Q000652:urine; D013395:Sucrose / Q000493:pharmacokinetics / Q000652:urine
chemical_list: D001786:Blood Glucose; D002241:Carbohydrates; D008353:Mannitol; D013395:Sucrose; D007785:Lactose; D011887:Raffinose