Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn's disease in remission.
OBJECTIVE
Crohn's disease (CD) is characterized by a reduction in mucosal integrity that permits antigen penetration into the intestinal tissue. The administration of probiotics has been suggested to improve the barrier function of the mucosa. The objective of this study was to evaluate the influence of Saccharomyces boulardii on the intestinal permeability in CD.


METHODS
Thirty-four patients were randomized according to the Vienna classification for treatment with either placebo or Saccharomyces boulardii. Baseline medications (mesalamine, azathioprine, prednisone, metronidazole and/or thalidomide) were maintained. Intestinal permeability (lactulose/mannitol ratio) was evaluated immediately before the beginning of treatment and at the end of the first and third treatment month. Fifteen healthy volunteers were also submitted for the intestinal permeability test.


RESULTS
In volunteers, the lactulose/mannitol ratio was 0.005+/-0.0037, whereas this value was 0.021+/-0.01 in patients with CD (p=0.001). In the placebo group, there was an increase in lactulose/mannitol ratio by 0.004+/-0.010 (p=0.12) at the end of the third month. In the S. boulardii group, there was an improvement in intestinal permeability, with a decrease in the lactulose/mannitol ratio by 0.008+/-0.006 (p=0.0005) in the same period.


CONCLUSIONS
Patients with CD in remission present alterations in the integrity of the intestinal mucosal barrier according to lactulose/mannitol ratio. S. boulardii added to baseline therapy improved intestinal permeability in these patients, even though complete normalization was not achieved.
Garcia Vilela
Eduardo
E
Alfa Institute of Gastroenterology-Clinic Hospital of the Federal University of Minas Gerais, Belo Horizonte, Brazil. evilela@medicina.ufmg.br
De Lourdes De Abreu Ferrari
Maria
M
Oswaldo Da Gama Torres
Henrique
H
Guerra Pinto
Ademar
A
Carolina Carneiro Aguirre
Ana
A
Paiva Martins
Fabiana
F
Marcos Andrade Goulart
Eugênio
E
Sales Da Cunha
Aloísio
A
D000328:Adult; D003424:Crohn Disease / Q000378:metabolism* / Q000628:therapy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007792:Lactulose / Q000494:pharmacology; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics; D008875:Middle Aged; D010539:Permeability; D019936:Probiotics / Q000627:therapeutic use*; D012074:Remission Induction; D012440:Saccharomyces
D008353:Mannitol; D007792:Lactulose