Abnormal small intestinal permeability in patients with idiopathic malabsorption in tropics (tropical sprue) does not change even after successful treatment.
BACKGROUND
Though tropical sprue (TS) is common in tropics, studies on small intestinal permeability (SIP) in TS are scant.


METHODS
SIP was evaluated using (1)H nuclear magnetic resonance (NMR) spectroscopy of urinary lactulose and mannitol in 24 patients with TS (22 before and 15 after treatment with tetracycline and folate) and in 31 healthy subjects (HS). Effect of treatment of TS on SIP and its relationship with outcome were studied.


RESULTS
Subjects were comparable in terms of age and gender. Before treatment, urinary lactulose (0.24 mmol, 0-1.09 mmol versus 0.09 mmol, 0-0.68 mmol, P=0.02) and lactulose-to-mannitol (L/M) ratio (0.11, 0-0.41 versus 0.042, 0-0.26, P=0.001) were higher in TS than in HS, though mannitol was comparable (2.7 mmol, 0.61-10.5 mmol versus 3.8 mmol, 1.3-16.4 mmol, P=0.08). Patients improved after treatment [stool frequency (9, 4-20/day versus 1, 1-2/day, P<0.0001), weight (44.4, 32-69 kg, versus 56, 39-84 kg, P<0.0001), fecal fat (10.1, 6-26 g/24 h versus 4.4, 3.0-6.7 g/24 h, P<0.0001), D-xylose (0.57, 0.28-1.2 g/5 g/5 h versus 1.1, 0.2-2.1 g/5 g/5 h, P<0.0001), and small intestinal bacterial overgrowth (SIBO) resolved in 10/24 (41.7%) versus 1/15 (6.6%), P=0.02]. Though urinary lactulose (0.17, 0-4.3 mmol versus 0.09, 0-0.68 mmol, P=0.11) and mannitol (2.17, 0.8-36.7 mmol versus 3.84, 1.3-16.4 mmol, P=0.06) were comparable, L/M ratio was higher in TS than in HS (0.09, 0-0.22 versus 0.042, 0-0.26, P=0.002). L/M ratio was more often abnormal (cutoff 0.078) in TS than in HS [14/22 (63.6%) versus 3/31 (9.7%); P=0.0001], which persisted even after treatment [9/15 (60%) as compared with HS; P=0.0006]. Persistently abnormal SIP was associated with less weight gain and frequent stools following treatment.


CONCLUSIONS
SIP is often abnormal in TS and remains unchanged even after successful treatment that was associated with less weight gain and more frequent stool.
Kumar
Sunil
S
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India.
Ghoshal
Uday C
UC
Jayalakshmi
Kamaiah
K
Roy
Raja
R
Misra
Asha
A
Khetrapal
C L
CL
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001944:Breath Tests; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D004386:Duodenum / Q000473:pathology; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000378:metabolism*; D007792:Lactulose / Q000652:urine; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008353:Mannitol / Q000652:urine; D008875:Middle Aged; D010539:Permeability; D013182:Sprue, Tropical / Q000188:drug therapy* / Q000378:metabolism* / Q000652:urine; D013752:Tetracycline / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D008353:Mannitol; D007792:Lactulose; D005492:Folic Acid; D013752:Tetracycline
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