Novel multi-sugar assay for site-specific gastrointestinal permeability analysis: a randomized controlled crossover trial.
OBJECTIVE
Increased gastrointestinal (GI) permeability is an important hallmark of many conditions, potentially leading to antigen exposure and sepsis. Current permeability tests are hampered by analytical limitations. This study aims to compare the accuracy of our multi-sugar (MS) and the classical dual sugar (DS) test for detection of increased GI permeability.


METHODS
Ten volunteers received permeability analysis using MS (1 g sucrose, lactulose, sucralose, erythritol, 0.5 g rhamnose in water) or DS (5 g lactulose, 0.5 g rhamnose), after indomethacin or placebo. Blood and urine were analyzed by isocratic LC-MS.


RESULTS
MS testing revealed significantly elevated urinary lactulose/rhamnose (L/R) ratios after indomethacin, due to enhanced lactulose excretion (P < .01) and unaltered rhamnose excretion. The DS test showed increased L/R ratios, due to increased lactulose excretion and decreased rhamnose excretion (both P < .05). After indomethacin, plasma L/R increased in both assays (P < .05 and P < .01). Urinary and plasma L/R ratios correlated significantly. Indomethacin increased sucrose excretion and 0-1 h sucrose/rhamnose. Colon permeability was unchanged.


CONCLUSIONS
Sensitive permeability analysis is feasible in plasma and urine using MS or DS test. In contrast to the DS test, monosaccharide excretion is not decreased by the MS test. In short, the MS test provides accurate, site-specific information on gastroduodenal, small, and large intestinal permeability. Registered at US National Library of Medicine (http://www.clinicaltrials.gov, NCT00943345).
Top Institute Food and Nutrition, Wageningen, The Netherlands. k.vanwijck@maastrichtuniversity.nl
Kim
K
van Wijck
Thomas J M
TJ
Verlinden
Hans M H
HM
van Eijk
Jan
J
Dekker
Wim A
WA
Buurman
Cornelis H C
CH
Dejong
Kaatje
K
Lenaerts
D000293:Adolescent; D000328:Adult; D000368:Aged; D002241:Carbohydrates / Q000032:analysis / Q000493:pharmacokinetics*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D041981:Gastrointestinal Tract / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000009:adverse effects; D007249:Inflammation / Q000503:physiopathology; D007792:Lactulose / Q000097:blood / Q000493:pharmacokinetics / Q000652:urine; D008297:Male; D008875:Middle Aged; D009005:Monosaccharides / Q000493:pharmacokinetics; D010539:Permeability; D012210:Rhamnose / Q000097:blood / Q000493:pharmacokinetics / Q000652:urine; D013395:Sucrose / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D055815:Young Adult
D002241:Carbohydrates; D009005:Monosaccharides; D007792:Lactulose; D013395:Sucrose; C026285:trichlorosucrose; D012210:Rhamnose; D007213:Indomethacin