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Updated: Aug 25, 2026

In Vitro and In Vivo Approaches to Determine Intestinal Epithelial Cell Permeability
Published on: October 19, 2018
Intestinal permeability is increased in patients with intermittent claudication
H Iwata1, M Matsushita, N Nishikimi
1First Department of Surgery, Nagoya University School of Medicine, Japan.
Purpose:
Intermittent claudication can be regarded as repeated ischemia reperfusion injury, which can induce a generalized increase in vascular permeability, including in intestine. The lactulose mannitol test (L/M test) was performed in patients with intermittent claudication to evaluate the change in intestinal permeability when they were forced to walk.
Methods:
The L/M test was performed in 11 patients with intermittent claudication and 11 control subjects without intermittent claudication. The test was performed at rest and after exercise. Patients walked on a treadmill until they stopped because of pain. The control subjects were forced to walk as far as 200 m on a treadmill. The L/M test was repeated in the patients after successful arterial reconstruction. Then the patients were instructed to walk the same distance at the same speed as they had before surgery.
Results:
In patients, the mean L/M ratio after exercise was significantly higher than the mean L/M ratio when they were at rest (0.068 +/- 0.053 vs 0.022 +/- 0.009, P <.05). In control subjects, however, no significant difference was observed between the mean L/M ratios after exercise and at rest. The mean L/M ratio after exercise, decreased from 0.068 +/- 0.053 to 0.018 +/- 0. 016 after successful arterial reconstruction (P <.05) in patients.
Conclusion:
Intestinal permeability, determined by means of the L/M test, significantly increased in patients with intermittent claudication after exercise, and it diminished after arterial reconstruction. The L/M test is, consequently, a new noninvasive method to reflect ischemia in lower limbs during exercise.
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