title: Intestinal permeability in children with recurrent respiratory and gastrointestinal symptoms.
abstract: OBJECTIVE
  Increased intestinal permeability has been reported in asthmatic subjects as well as in patients with gastrointestinal disease, thus suggesting the involvement of all the mucosal immune system. We aimed to assess intestinal permeability according to recurrent respiratory and gastrointestinal symptoms in children with asthma and children with functional gastrointestinal disorders (FGIDs).
  
  
  METHODS
  In 108 outpatients aged 3-14 years (45 asthmatic, 63 with FGIDs), we measured the urinary lactulose/mannitol (L/M) ratio, performed allergy skin prick tests and administered questionnaires for recurrent respiratory and gastrointestinal symptoms starting from at least 2 months which persisted over the previous 4 weeks. L/M ratios were compared with previously reported normal values yielded by our chromatographic method (liquid chromatography-mass spectrometry).
  
  
  RESULTS
  High L/M ratios (>0.030) were less frequent in asthmatic children than in children with FGIDs (9/45: 20% vs. 41/63: 65%, P < 0.001). High L/M ratios were associated with gastrointestinal symptoms in 8/9 asthmatic (P < 0.05) and 39/41 subjects with FGIDs (P < 0.005). L/M ratios were not associated with respiratory symptoms or atopy. In a regression model, a high L/M was predicted by low height, absence of asthma and presence of gastrointestinal symptoms (r = 0.72, P < 0.001).
  
  
  CONCLUSIONS
  Increased intestinal permeability is associated with recurrent gastrointestinal symptoms rather than with recurrent respiratory symptoms in both asthmatic children and those with FGIDs. Our findings do not support the hypothesis of mucosal intestinal damage following an inflammatory stimulus in the respiratory mucosa.
authors.affiliation: Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Barreto
authors.affiliation: Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Melania
authors.initials: M
authors.lastname: Evangelisti
authors.affiliation: Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Principessa
authors.affiliation: Advanced Molecular Diagnostic Unit, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Simmaco
authors.affiliation: Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Negro
authors.affiliation: Advanced Molecular Diagnostic Unit, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Lionetto
authors.affiliation: Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Campisano
authors.affiliation: Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Villa
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000378:metabolism* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000503:physiopathology; D007792:Lactulose / Q000652:urine; D008297:Male; D008353:Mannitol / Q000652:urine; D010539:Permeability; D012008:Recurrence; D012882:Skin Tests; D011795:Surveys and Questionnaires
chemical_list: D008353:Mannitol; D007792:Lactulose
keywords: asthma; child; functional gastrointestinal disorder; inflammation; intestinal permeability; recurrent respiratory symptom