Intestinal absorption and permeability in paediatric short-bowel syndrome:A pilot study

Background: Sugar absorption tests are an effective, noninvasive way to ass ess intestinal permeability. The role of intestinal barrier integrity in co mplications and outcome of short-bowel syndrome is not known. The purpose o f the study was to evaluate whether such tests provide information on the s tatus of intestinal mucosa of these patients. Methods: Six children with short-bowel syndrome-median age, 12 months, and median small bowel length at birth, 30 cm-had a sugar test with 3-o-methyl- D-glucose, D-xylose, D-rhamnose, and melibiose approximately 2 months after operation. The melibiose/L-rhamnose ratio was used as an index of permeabi lity, and percentages of 3-o-methyl-D-glucose and D-xylose absorbed were us ed as indices of absorption. Parenteral nutrition requirement, bowel length , liver disease, recent sepsis, and bacterial overgrowth were recorded. Results: Three patients had increased permeability, and all of them had had a recent episode of sepsis and severe liver dis-ease. All subjects had mal absorption of 3-o-methyl-D-glucose, and five of six had malabsorption of D- xylose and L-rhamnose. The absorption of 3-o-methyl-D-glucose correlated wi th bowel length (r(2) = 0.78; P = 0.04), whereas the absorption of D-xylose correlated with parenteral requirement (r(2) = 0.66; P = 0.04) at that tim e. Conclusions: Increased permeability was observed in three of six patients w ith short-bowel syndrome associated with a recent episode of sepsis and sev ere liver disease. Other indices of malabsorption correlated significantly with different clinical features of the disease. A prospective larger scale study in a homogeneous population is indicated to assess at multiple point s during the disease course whether the test can be helpful in the manageme nt of these patients.