EVALUATION OF INTESTINAL PERMEABILITY IN PATIENTS WITH INFLAMMATORY BOWEL-DISEASE USING LACTULOSE AND MEASURING ANTIBODIES TO LIPID-A

This study looked at the intestinal permeability and the immune respon se to enteric bacterial antigens in patients with inflammatory bowel d isease (IBD). They were evaluated by using a lactulose tolerance test and measuring blood anti-lipid A antibody concentrations, respectively . The lactulose tolerance tests were performed 22 times in 14 patients with Crohn's disease (CD), 19 times in 12 patients with ulcerative co litis (UC), and 12 times in 12 healthy controls. Blood lactulose conce ntrations were measured after oral administration every two hours for eight hours, also blood C reactive protein concentrations and anti-lip id A antibody concentrations were measured just before lactulose admin istration. Blood lactulose concentrations were significantly higher in patients with CD than in the controls from two to eight hours after a dministration, while in UC they were significantly higher than in the controls from six to eight hours. Maximum blood lactulose concentratio ns in each tolerance test in patients with the active phase significan tly exceeded those in the inactive phase of either CD or UC. A signifi cant correlation was also seen between the maximum blood lactulose con centrations and the C reactive protein concentrations. Blood anti-lipi d A antibody concentrations in patients with CD were significantly hig her than in the controls as well as in patients with UC in immunoglobu lin (Ig) A class and IgG class. In UC they were significantly higher t han in the controls in IgA class. But, they were not related to the se verity of the disease of either CD or UC, and not correlated significa ntly with the maximum blood lactulose concentrations in either CD or U C. The intestinal permeability and the immune response to enteric bact erial antigens in patients with inactive CD were significantly increas ed over those in the controls as well as in patients with inactive UC. These findings suggest that an increase of the intestinal permeabilit y and that of producing antibodies to enteric bacterial antigens are b oth important for the pathogenesis of IBD, and that the characteristic s of CD and UC differ.