Corticosteroid therapy augments gastroduodenal permeability to sucrose

Objective: The aim of the present study was to investigate whether corticos teroid therapy alters gastroduodenal mucosal permeability and whether perme ability alteration is associated with macroscopic mucosal damage. Methods: Eight patients taking oral corticosteroid therapy (total prednisone-equival ent dose, 1.5 +/- 0.1 g; duration, similar to 30 days), nine patients with multiple sclerosis taking high-dose intravenous methyl-prednisolone therapy (total dose, 11.7 +/- 0.5 g; duration, similar to 9 days), and 20 age- and gender-matched controls were studied. Gastroduodenal permeability was dete rmined using sucrose as a site-specific permeability probe. Five-hour urine was collected after ingesting 100 g of sucrose and its urinary excretion r ate was measured using high-pressure liquid chromatography, Gastroduodenal endoscopy was performed before steroid therapy to exclude subjects with evi dence of macroscopic mucosal lesions. The sucrose test and endoscopy were r epeated after completion of corticosteroid therapy. Results: The urinary su crose excretion rates were similar in the control group and in patient grou ps before corticosteroid therapy, The median excretion rate of sucrose incr eased four (one to 28)- and eight (two to 35)-fold, respectively, as compar ed with pretreatment values in patients taking oral steroid and high-dose i ntravenous methyl-prednisolone therapy (p < 0.01), Considering all patients together, subjects who received a mean prednisone-equivalent dose of 8.4 /- 1.5 g exhibited mucosal lesions, whereas patients who received 3.3 +/- 1 .8 g did not (p = 0.06). The posttherapy increments in sucrose excretion ra tes were associated with neither the presence of macroscopic lesions nor wi th the total steroid dose received. Conclusions: Corticosteroid therapy aug ments gastroduodenal permeability and high doses are associated,vith macros copic mucosal lesions. Steroid-induced permeability increase does not appea r to be associated with the presence of macroscopic mucosal lesions. (C) 19 98 by Am. Coll. of Gastroenterology.