Effects of therapy with lansoprazole on intestinal permeability and inflammation in young cystic fibrosis patients

Background: Defective pancreatic bicarbonate secretion with low intestinal pH or intestinal inflammation of any origin increase intestinal permeabilit y in cystic fibrosis (CF). Methods: In this open study, the authors evaluated the effect of a proton-p ump inhibitor on intestinal permeability and inflammation in 14 young, panc reatic-insufficient CF patients. Permeability was measured by a three-sugar permeability test before and after 1 year of lansoprazole pse, and urinary nitric oxide (NO) oxidation products were assessed before and during that year as a marker of inflammation. Results: After 1 year of lansoprazole use, median urinary recovery percenta ges changed from 2.5% to 1.7% (P = 0.064), from 24.9% to 24.5% (no signific ance), and from 10.5% to 11.1% (no significance) for lactulose, mannitol, a nd L-rhamnose, respectively. Despite the fact that the median urinary excre tion ratios decreased from 0.108 to 0.083 (P = 0.03) and from 0.246 to 0.17 6 (P = 0.016) for lactulose and mannitol and for lactulose and rhamnose, re spectively, they both remained increased. Median urinary NO products-to-cre atinine ratios were 0.287 for CF patients before lansoprazole and 0.130 for healthy control participants (P = 0.002). Although there was a tendency to ward a decrease in the NO products-to-creatinine ratio during treatment, th is was not significant at the end point. Conclusions: Intestinal permeability is considerably increased in CF patien ts and is partly corrected after the use of a proton-pump inhibitor for 1 y ear, which may point to a harmful effect of the acid luminal contents on th e tight junctional related paracellular permeability pathway. The start and end values for the NO products-to-creatinine ratio in CF patients were not significantly different, but were considerably increased when compared wit h control participants (P = 0.002).