Over the past decade, there has been considerable interest in changes to gut permeability as the association between intestinal inflammation, increased permeability and auto-immune disease has become well established. The penetration of the intestinal mucosal barrier appears to correlate with clinical disease such as infection, food allergy, Crohn’s disease, coeliac disease, dermatological
conditions, colitis and auto-immune diseases such as rheumatoid arthritis, ankylosing spondylitis and Reiter’s syndrome, as well as eczema and other ‘allergic’ disorders. Decreased permeability
appears to be a fundamental cause of malnutrition, malabsorption and failure to thrive.
The measurement of passive permeability using the dual sugar technique (lactulose and mannitol) may be the most useful, precise and non-invasive method for assessing mucosal integrity in the small bowel. Mannitol (a monosaccharide) and lactulose (a disaccharide) are water soluble molecules that are not metabolised by the body. Mannitol is readily absorbed and lactulose is only slightly absorbed. Measuring the recovery of these sugars in the urine accurately reflects the extent of permeability or malabsorption.
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