GASTROINTESTINAL PERMEABILITY IN CELIAC-DISEASE

Background & Aims: Intestinal permeability is increased in patients wi th active celiac disease. The measurement of sucrose permeability is p roposed as a novel means to detect upper gastrointestinal damage, with potentially greater use than conventional methods. The aim of this st udy was to evaluate the effectiveness of sucrose in the detection of c eliac disease. Methods: Permeability tests were performed in 27 newly diagnosed patients, at diagnosis, after upper gastrointestinal endosco pies were performed to exclude macroscopic gastric lesions, and after 2 months on a gluten-free diet. Results were compared with those obtai ned in 30 healthy subjects and 7 patients with chronic diarrhea but no evidence of celiac disease. Results: At diagnosis, 25 of 27 patients had increased urinary excretion of sucrose. Mean sucrose excretion in patients with untreated celiac disease was significantly increased com pared with healthy controls and controls with disease. Sucrose excreti on decreased significantly after treatment and completely normalized i n 60% of patients. The lactulose-mannitol ratio was abnormal in 26 of 27 patients, with a mean value significantly greater than that observe d in healthy controls. This ratio also significantly declined after tr eatment; however, no values returned to the normal range. Conclusions: Increased sucrose permeability is a sensitive marker for advanced cel iac disease. Moreover, it decreases rapidly in response to a gluten-fr ee diet and therefore is potentially useful to follow response to ther apy.