Development and Validation of Test for “Leaky Gut” Small Intestinal and Colonic Permeability Using Sugars in Healthy Adults

• DOI: 10.1053/j.gastro.2021.04.020
• Publication Date: 2021-04-16T15:45:03Z
• Authors: Katayoun Khoshbin; Lehar Khanna; Daniel Maselli; Jessica Atieh; Margaret Breen-Lyles; Kayla Arndt; Deborah Rhoten; Roy B. Dyer; Ravinder J. Singh; Sunita Nayar; Sandra Bjerkness; William S. Harmsen; Irene Busciglio; Michael Camilleri
• Keywords: Lactulose; Sucralose; Intestinal Permeability; Rhamnose; Monosaccharide; Galactosemia

BackgroundOral monosaccharides and disaccharides are used to measure in vivo human gut permeability through urinary excretion.AimsThe aims were as follows: (1) obtain normative data on small intestinal colonic permeability; (2) assess variance standard 16 g fiber diet performed twice; (3) determine whether dietary influences measurements; (4) present pilot using 2 selected probes patients with diarrhea-predominant irritable bowel syndrome (IBS-D).MethodsSixty healthy female male adults, age 18–70 years, participated 3 randomized studies (2 16.25 1 study 32.5 fiber) otherwise standardized diets. At each test, the following sugars ingested: 12C-mannitol, 13C-mannitol, rhamnose (monosaccharides), sucralose, lactulose (disaccharides). Standardized meals administered from 24 hours before during post-sugars urine collections: 0–2, 2–8, 8–24 hours. Sugars measured high-performance liquid chromatography–tandem mass spectrometry. Eighteen IBS-D underwent 24-hour excretion after oral 13C-mannitol lactulose.ResultsBaseline (>3-fold above lower limits of quantitation) identified studies: 12C-mannitol all participants; sucralose 4–8, 1–3. Median excretions/24 h (percentage dose) for rhamnose, lactulose, ∼30%, ∼15%, 0.32%, 2.3%, respectively. reflected mainly permeability. Intraindividual saccharide excretions consistent, minor differences vs interindividual coefficient variation was 76.5% (10–90 percentile: 34.6–111.0). There no significant effects sex, age, or body index measurements health. feasible IBS-D.ConclusionsBaseline precludes its use; is preferred probe Oral excretion. The (IBS-D). Sixty lactulose. Baseline IBS-D.