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P011 Evaluation the intestinal barrier function patients with inflammatory bowel disease

Abdulganieva D.*1, Mukhametova D.1, Koshkin S.2, Zinkevich O.3, Saphina N.3, Abdulkhakov S.1,2, Odintsova A.4, Koporulina M.3

1Kazan State Medical University, Kazan, Russian Federation 2Kazan (Volga region) Federal University, Kazan, Russian Federation 3Kazan State Medical Academy, Kazan, Russian Federation 4Republican Clinical Hospital, Kazan, Russian Federation

Background

Inflammatory bowel disease (IBD) characterized by increased intestinal permeability (IP). This leads to bacterial translocation and systemic endotoxemia, which cause immuno-inflammatory response.

Aim: to evaluate the intestinal barrier function in patients with IBD.

Methods

We prospectively included 119 patients with IBD – 80 patients with ulcerative colitis (UC) and 39 patients with Crohn's disease (CD) and 20 healthy controls. All included into the study had assessment of passive IP – the level of systemic endotoxemia using the Limulus Amebocyte Lysate (LAL) test. 60 patients with IBD (33 UC and 27 CD) went through evaluation of active IP – triple sugar test using the high performance liquid chromatography. Small bowel IP 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 control group – 30.13±1.5. Severity of UC was assessed by Mayo score and in CD by CDAI.

Results

Increase of endotoxin level was observed during in exacerbation of CD (0.065±0.04 EU/ml; p<0.01), remission (0.012±0.01 EU/ml; p<0.05) comparing with healthy controls (0.00038±0.0003 EU/ml). There was increasing of small bowel IP and colonic permeability – 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]) (p<0.01) and in healthy controls (0.011 [0.009; 0.017]) (p<0.001). There was the relationship with disease severity and location of CD. There was tendency to increasing of colonic permeability in group of patients with colitis of CD.

Analysis of IP in UC had revealed an increase of endotoxin level in active stage (0.014±0.006 EU/ml; p<0.05) remission (0.0019±0.001EU/ml; p<0.05) comparing with control group (0.00038±0.0003 EU/ml). Small IP in exacerbation of UC 0.021 [0.014; 0.034] was higher than in remission (0.006 [0.005; 0.01]) (p<0.01) and in healthy (0.011 [0.009; 0.017]) (p<0.01). Colonic permeability in active UC (1600 [700.8; 2185.6] nmol/l) was increased compared with remission UC (374.4 [267.2; 481.3] nmol/l) (p<0.01) and healthy (819.2 [521.6; 1044.8] nmol/l) (p<0.01). There was the relationship with disease severity and lesion extending of UC.

Endotoxemia was higher in colonic lesions than the small intestinal. Endotoxin level in colitis of CD and UC was higher than in ileitis of CD. Level of endotoxin in blood increased with increasing of sucralose level in urine in UC (r=0.54; p<0.05) and in CD (r=0.28; p<0.05).

Conclusion

Patients with IBD had an increased IP with a predominant increase of small IP in CD and more pronounced changes of IP in UC. There was found increased systemic endotoxemia, more pronounced in patients with CD and with colonic lesions of IBD.