Uil J J, van Elburg R M, van Overbeek F M, Meyer J W, Mulder C J, Heymans H S
Department of Hepatogastroenterology, University Hospital Utrecht, The Netherlands.
Eur J Gastroenterol Hepatol. 1996 Mar;8(3):219-23. doi: 10.1097/00042737-199603000-00006.
To determine whether the sugar absorption test (SAT) during follow-up of patients with coeliac disease on a gluten-free diet (GFD) correlates with improvement of the villous architecture of the small intestine.
The SAT was performed in coeliacs at diagnosis and during follow-up with GFD. For the SAT, a solution of lactulose (L) and mannitol (M) was given to the fasting patient and the L-M ratio calculated in a 5-hour urine sample by gas chromatography: ratios > 0.089 are considered abnormal. The solution was made hyperosmolar by adding sucrose (1560 mmol/l).
The L-M ratio was 2-3 times higher at diagnosis than either at 8 months to 2 years gluten free, or beyond 2 years gluten free, consecutively. The L-M ratio (mean, range) was significantly higher in cases of biopsies with (sub)total villous atrophy (VA) (0.388, 0.062-0.804, n = 28), partial VA (0.240, 0.062-0.841, n = 18) and villous irregularity (0.143, 0.017-0.322, n = 29) than in case of normalized histology after GFD (0.085, 0.021-0.230, n = 19). The rate of normalization of functional integrity was slower in adults than in children, demonstrated by a combination of histology and SAT.
The SAT correlates well with the degree of VA. It is important for daily clinical practice that the simple and non-invasive SAT can be used as an indicator of intestinal damage, thus influencing need for and timing of intestinal biopsies.
确定乳糜泻患者在无麸质饮食（GFD）随访期间的糖吸收试验（SAT）是否与小肠绒毛结构的改善相关。
在乳糜泻患者诊断时及GFD随访期间进行SAT。对于SAT，向空腹患者给予乳果糖（L）和甘露醇（M）溶液，并通过气相色谱法计算5小时尿液样本中的L-M比值：比值>0.089被认为异常。通过添加蔗糖（1560 mmol/l）使溶液变为高渗。
诊断时的L-M比值比连续无麸质饮食8个月至2年或超过2年时高2至3倍。在（亚）全绒毛萎缩（VA）（0.388，0.062 - 0.804，n = 28）、部分VA（0.240，0.062 - 0.841，n = 18）和绒毛不规则（0.143，0.017 - 0.322，n = 29）的活检病例中，L-M比值显著高于GFD后组织学正常的病例（0.085，0.021 - 0.230，n = 19）。组织学和SAT相结合表明，成人功能完整性的正常化速度比儿童慢。
SAT与VA程度密切相关。简单且无创的SAT可作为肠道损伤的指标用于日常临床实践，从而影响肠道活检的必要性和时机，这一点很重要。
