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Alterations of intestinal permeability to sugars in infants following neonatal surgery
1Department of Pediatrics, Hôpital Saint Vincent de Paul, Paris, France.
Insights
Urinary recovery of mannitol and lactulose effectively identifies intestinal mucosal damage in infants with surgical gastrointestinal disorders. This non-invasive test aids in diagnosing conditions like short bowel syndrome and necrotizing enterocolitis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biomarker Discovery
Background:
- Infants with gastrointestinal surgical disorders often present with complex diagnostic challenges.
- Assessing intestinal mucosal integrity is crucial for timely and effective treatment.
Purpose of the Study:
- To evaluate the utility of urinary lactulose and mannitol recovery as biomarkers for intestinal mucosal damage in infants.
- To differentiate between healthy infants and those with specific surgical gastrointestinal conditions.
Main Methods:
- Oral administration of lactulose and mannitol to 29 infants (3 days-20 months) in a pediatric intensive care unit and 24 healthy controls.
- Measurement of 12-hour urinary excretion of both sugars.
- Calculation of the lactulose/mannitol urinary ratio.
Main Results:
- A significant fourfold reduction in urinary mannitol was observed in infants with short bowel syndrome compared to controls.
- The lactulose/mannitol ratio was significantly elevated in infants with necrotizing enterocolitis and intestinal propulsion disorders during diarrhea.
- These findings suggest a strong correlation between urinary sugar recovery patterns and intestinal mucosal integrity.
Conclusions:
- Urinary recovery of orally ingested mannitol and lactulose serves as a reliable non-invasive marker for intestinal mucosal damage in infants undergoing gastrointestinal surgery.
- This diagnostic approach can aid in the early identification of conditions such as short bowel syndrome and necrotizing enterocolitis.
Abstract:
The 12-h urinary elimination of orally ingested mannitol and lactulose was studied in 29 infants aged 3 days-20 months admitted in an intensive care unit of gastrointestinal surgery, and in 24 age-matched healthy controls. In patients with short bowel syndrome, there was a significant fourfold reduction in urinary mannitol elimination compared with controls. The lactulose/mannitol urinary ratio was significantly increased in patients with necrotizing enterocolitis (p less than 0.01) and in patients with disorders of intestinal propulsion during episodes of diarrhea with a monomorphic fecal flora (p less than 0.01). The urinary recovery of mannitol and lactulose after oral loads is a good marker of intestinal mucosal damage in infants with surgical disorders of the digestive tract.