Abnormal intestinal permeability in primary biliary cirrhosis.

Area of Science:

• Gastroenterology
• Immunology
• Hepatology

Background:

• Antimitochondrial antibodies (AMAs) in primary biliary cirrhosis (PBC) may arise from molecular mimicry with gut bacteria.
• Increased gastrointestinal permeability could facilitate immune system exposure to gut flora.

Purpose of the Study:

• To compare gastrointestinal permeability in PBC patients versus hepatitis C patients and healthy controls.
• To investigate the role of gut permeability in the development of AMAs in PBC.

Main Methods:

• Subjects ingested a mixture of sucrose, lactulose, and mannitol.
• Eight-hour urinary sugar excretion was measured to assess gastric, proximal small intestinal, and small bowel permeability.
• Antiendomysial antibody testing excluded subclinical celiac disease.

Main Results:

• PBC patients showed significantly higher sucrose excretion, indicating abnormal gastric or proximal small intestinal permeability.
• Elevated lactulose:mannitol ratio in PBC patients suggested increased small bowel permeability compared to controls.
• Hepatitis C patients did not exhibit increased sucrose excretion but had similar lactulose:mannitol ratios to PBC patients.

Conclusions:

• Primary biliary cirrhosis is associated with increased permeability in both the stomach and small bowel.
• The exact relationship between increased gut permeability and PBC (cause, consequence, or manifestation) remains undetermined.