Abnormal intestinal permeability in subgroups of diarrhea-predominant irritable bowel syndromes.
OBJECTIVE
Irritable bowel syndrome (IBS) is a heterogeneous condition and defined according to symptoms. Low-grade inflammation has been associated with IBS, particularly that following infection, but whether altered intestinal permeability profiles relate to irritable bowel subtype or onset is uncertain. Our aim was to compare small and large intestinal permeability in various subtypes of IBS to healthy controls.


METHODS
Intestinal permeability was measured using 1.8 MBq of 51Cr-EDTA and collecting urine over 24 h; Study 1: patients with diarrhea-predominant postinfectious IBS (N=15), constipation-predominant IBS (N=15), and healthy controls (N=15); Study 2: two groups of diarrhea-predominant IBS (D-IBS), one with a history of onset after acute gastroenteritis (postinfectious) (N=15) and the other without such a history (nonpostinfectious) (N=15) both compared with healthy controls (N=12).


RESULTS
Permeability expressed as percentage of total dose excreted in urine (median [inter-quartile range]). Study 1: Proximal small intestinal permeability was increased in postinfectious IBS (0.19 [0.12-0.23]) in contrast to constipated IBS (0.085 [0.043-0.13]) and controls (0.07 [0.035-0.19]) (p=0.02). IBS patients with eczema, asthma, or hayfever had increased proximal small intestinal permeability compared with IBS patients without atopy (p=0.02). Study 2: Small intestinal permeability was greater in nonpostinfectious diarrhea-predominant IBS (0.84 [0.69-1.49]) compared with postinfectious IBS (0.43 [0.29-0.63], p=0.028) or controls (0.27 [0.2-0.39]), p=0.001).


CONCLUSIONS
Small intestinal permeability is frequently abnormal in diarrhea-predominant IBS. Those without a history of infectious onset appear to have a more severe defect.
Dunlop
Simon P
SP
Wolfson Digestive Diseases Centre and Division of Medical Physics, University Hospital, Nottingham, United Kingdom.
Hebden
John
J
Campbell
Eugene
E
Naesdal
Jorgen
J
Olbe
Lars
L
Perkins
Alan C
AC
Spiller
Robin C
RC
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D002859:Chromium Isotopes / Q000652:urine; D003967:Diarrhea / Q000503:physiopathology* / Q000652:urine; D004492:Edetic Acid / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D043183:Irritable Bowel Syndrome / Q000503:physiopathology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010539:Permeability; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D002859:Chromium Isotopes; D004492:Edetic Acid