P081 Evaluation of intestinal permeability with a triple sugar test in inflammatory bowel disease
D. Mukhametova1, D. Abdulganieva*1, S. Koshkin2, S. Abdulhakov1, A. Odintsova3
1Kazan State Medical University, Kazan, Russian Federation, 2Kazan (Volga region) Federal University, Kazan, Russian Federation, 3Republican Clinical Hospital, Kazan, Russian Federation
It is thought that increased intestinal permeability plays a critical role in the pathogenesis of inflammatory bowel disease (IBD). Further, it contributes to excessive antigenic stimulation, which leads to the development of immuno-mediated inflammatory response in the intestinal wall and ultimately to IBD. Aim: to evaluate the intestinal permeability in patients with IBD.
We prospectively included 60 patients with IBD: 27 patients with Crohn’s disease (CD), 33 patients with ulcerative colitis (UC), and 20 healthy controls. Everyone held a triple sugar test using high-performance liquid chromatography. Small intestinal permeability was assessed by lactulose/mannitol ratio, colonic permeability–levels of sucralose in urine. Mean age in UC was 38.03 ± 1.14 years; CD, 34.7 ± 1.5, and in the control group, 30.13 ± 1.5. Severity of UC was assessed by Mayo score: remission – 7, mild – 11, moderate –9, severe – 6, in CD by CDAI and remission – 6, mild – 6, moderate – 9, severe – 6.
There was increasing of small intestinal and colonic permeability in patients with IBD. Levels of lactulose/mannitol ratio in active CD was higher (0.042 [0.021; 0,077]) than in remission (0.009 [0.006; 0.01]) (р < 0.01) and in healthy controls (0.011 [0.009; 0.017]) (р <0,001). There was the relationship with disease severity and location of CD. However, increasing colonic permeability in CD were noted. There was tendency to increasing of colonic permeability in the group of patients with colitis of CD. Analysis of permeability in UC had revealed an increase of small intestinal permeability in these patients. Thus, lactulose/mannitol ratio in exacerbation of UC 0.021 [0.014; 0.034] was higher than in remission (0.006 [0.005; 0.01]) (р < 0.01) and in healthy (0.011 [0.009; 0.017]) (р < 0,01). Patients with UC showed a significant increasing of colonic permeability–levels of sucralose in urine in patients with active UC (1 600 [700.8; 2 185.6] nmol/l) was increased compared with remission UC (374.4 [267.2; 481.3] nmol/l) (р < 0.01) and healthy (819.2 [521.6; 1044.8] nmol/l) (р < 0.01). There was the relationship with disease severity and lesion extending of UC. A correlation was found between intestinal and colonic permeability. In CD, lactulose/mannitol ratio decreased with increasing of levels of sucralose in urine (r = -0.60; p < 0.05). In UC lactulose/mannitol ratio increased with increasing of levels of sucralose in urine (r = 0.55; p < 0.05).
Patients with IBD had an increased intestinal permeability with a dominant increase of small intestinal permeability in CD and colonic permeability in UC. In ulcerative colitis, more pronounced changes of intestinal permeability were found.