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Published on: December 1, 2012
Intestinal absorption and permeability in paediatric short-bowel syndrome: a pilot study
L D'Antiga1, A Dhawan, M Davenport
1Department of Child Health, Guy's, King's, St. Thomas School of Medicine, London, United Kingdom.
Insights
Sugar absorption tests can reveal intestinal issues in short-bowel syndrome (SBS) patients. Malabsorption and increased permeability were linked to sepsis, liver disease, and parenteral nutrition needs in children with SBS.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Intestinal Physiology
Background:
- Short-bowel syndrome (SBS) poses challenges in assessing intestinal barrier integrity and mucosal status.
- Noninvasive sugar absorption tests are established methods for evaluating intestinal permeability.
Observation:
- Six pediatric patients with SBS underwent sugar absorption testing (3-o-methyl-D-glucose, D-xylose, D-rhamnose, melibiose) post-operation.
- Key clinical factors including parenteral nutrition, bowel length, liver disease, sepsis, and bacterial overgrowth were recorded.
Findings:
- Three patients exhibited increased intestinal permeability, correlating with recent sepsis and severe liver disease.
- Malabsorption of 3-o-methyl-D-glucose was universal, while D-xylose and L-rhamnose malabsorption affected five out of six patients.
- Absorption of 3-o-methyl-D-glucose correlated with remaining bowel length (r2=0.78), and D-xylose absorption correlated with parenteral nutrition requirements (r2=0.66).
Implications:
- Sugar absorption tests may offer valuable insights into the mucosal status and complications of short-bowel syndrome.
- Further prospective studies in homogeneous populations are warranted to validate these findings for clinical management.
- These tests could potentially aid in monitoring disease progression and guiding treatment strategies in pediatric SBS patients.
Background:
Sugar absorption tests are an effective, noninvasive way to assess intestinal permeability. The role of intestinal barrier integrity in complications and outcome of short-bowel syndrome is not known. The purpose of the study was to evaluate whether such tests provide information on the status 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 permeability, and percentages of 3-o-methyl-D-glucose and D-xylose absorbed were used 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 disease. All subjects had malabsorption 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 with bowel length (r2 = 0.78; P = 0.04), whereas the absorption of D-xylose correlated with parenteral requirement (r2 = 0.66; P = 0.04) at that time.
Conclusions:
Increased permeability was observed in three of six patients with short-bowel syndrome associated with a recent episode of sepsis and severe 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 points during the disease course whether the test can be helpful in the management of these patients.
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