van Elburg R M, Uil J J, Mulder C J, Heymans H S
Department of Paediatrics, University Hospital of Groningen, The Netherlands.
Gut. 1993 Mar;34(3):354-7. doi: 10.1136/gut.34.3.354.
The functional integrity of the small bowel is impaired in coeliac disease. Intestinal permeability, as measured by the sugar absorption test probably reflects this phenomenon. In the sugar absorption test a solution of lactulose and mannitol was given to the fasting patient and the lactulose/mannitol ratio measured in urine collected over a period of five hours. The sugar absorption test was performed in nine patients with coeliac disease with an abnormal jejunum on histological examination, 10 relatives of patients with coeliac disease with aspecific symptoms but no villous atrophy, six patients with aspecific gastrointestinal symptoms but no villous atrophy, and 22 healthy controls to determine whether functional integrity is different in these groups. The lactulose/mannitol ratio (mean (SEM) is significantly higher in both coeliac disease (0.243 (0.034), p < 0.0001)) and relatives of patients with coeliac disease (0.158 (0.040), p < 0.005)) v both healthy controls (0.043 (0.006)) and patients with aspecific gastrointestinal symptoms (0.040 (0.011)). The lactulose/mannitol ratio in relatives of coeliac disease patients was significantly lower than in the coeliac disease patient group (p = 0.04). The lactulose/mannitol ratio was the same in healthy controls and patients with aspecific gastrointestinal symptoms. It is concluded that the sugar absorption test is a sensitive test that distinguishes between patients with coeliac disease and healthy controls. The explanation for the increased permeability in relatives of patients with coeliac disease is uncertain. Increased intestinal permeability may be related to constitutional factors in people susceptible to coeliac disease and may detect latent coeliac disease. The sugar absorption test may therefore be helpful in family studies of coeliac disease.
乳糜泻患者小肠的功能完整性受损。通过糖吸收试验测量的肠道通透性可能反映了这一现象。在糖吸收试验中，给空腹患者服用乳果糖和甘露醇溶液，并测量五小时内收集尿液中的乳果糖/甘露醇比值。对9例经组织学检查空肠异常的乳糜泻患者、10例有非特异性症状但无绒毛萎缩的乳糜泻患者亲属、6例有非特异性胃肠道症状但无绒毛萎缩的患者以及22名健康对照者进行了糖吸收试验，以确定这些组的功能完整性是否存在差异。与健康对照者（0.043（0.006））和有非特异性胃肠道症状的患者（0.040（0.011））相比，乳糜泻患者（0.243（0.034），p<0.0001）和乳糜泻患者亲属（0.158（0.040），p<0.005）的乳果糖/甘露醇比值均显著更高。乳糜泻患者亲属的乳果糖/甘露醇比值显著低于乳糜泻患者组（p = 0.04）。健康对照者和有非特异性胃肠道症状的患者的乳果糖/甘露醇比值相同。结论是，糖吸收试验是一种敏感的试验，可区分乳糜泻患者和健康对照者。乳糜泻患者亲属通透性增加的原因尚不确定。肠道通透性增加可能与易患乳糜泻人群的体质因素有关，可能检测出潜在的乳糜泻。因此，糖吸收试验可能有助于乳糜泻的家族研究。
