Related Experiment Videos
Intestinal permeability changes in acute gastroenteritis: effects of clinical factors and nutritional management
E Isolauri1, M Juntunen, S Wiren
1Department of Pediatrics, Tampere University Central Hospital, Finland.
Insights
Early home feeding for acute diarrhea in children helps maintain normal intestinal permeability. Fasting, however, worsens gut permeability, delaying recovery from gastroenteritis.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Permeability Research
- Microbiome and Gut Health
Background:
- Acute gastroenteritis in children, often caused by rotavirus, can lead to increased intestinal permeability.
- Traditional management sometimes involves fasting, which may impact gut barrier function.
- Understanding the role of early feeding versus fasting in recovery is crucial for pediatric care.
Purpose of the Study:
- To investigate the impact of early home management (feeding) versus fasting on intestinal permeability in children with acute gastroenteritis.
- To assess the effect of in-hospital realimentation on gut permeability.
- To compare intestinal permeability markers between children managed with early feeding and those who fasted.
Main Methods:
- A study involving 41 children (3-25 months) with acute gastroenteritis.
- Administration of an oral lactulose/mannitol load post-rehydration.
- Analysis of urinary lactulose/mannitol ratio using gas-liquid chromatography to measure intestinal permeability.
Main Results:
- Children receiving uninterrupted feeding at home had a normal lactulose/mannitol ratio (0.04).
- Fasted children showed significantly higher ratios (0.24 or 0.14), indicating increased intestinal permeability.
- In-hospital realimentation did not significantly alter permeability ratios upon retesting.
Conclusions:
- Fasting exacerbates the increased intestinal permeability associated with acute gastroenteritis.
- Early home feeding appears to promote the reduction of intestinal permeability and may hasten recovery.
- This suggests that early nutritional support is beneficial for gut barrier function in pediatric gastroenteritis.
Abstract:
The effects of early home management of acute diarrhea followed by rapid in-hospital realimentation on intestinal permeability were studied in 41 children aged 3-25 months with acute gastroenteritis (73% rotavirus). After oral rehydration, a 100 ml oral load containing 4 g of lactulose and 0.8 g of mannitol was administered, and an aliquot of urine excreted in the subsequent 5 h was analyzed with gas-liquid chromatography. The mean lactulose/mannitol recovery ratio was significantly higher than in 28 nondiarrheal controls, which was due to decreased mannitol excretion. The gastroenteritis patients who had received uninterrupted feeding in addition to adequate fluid replacement before hospitalization had a normal urinary lactulose/mannitol ratio, with a mean of 0.04, and a 95% confidence interval (CI) of [0.03, 0.07], whereas in fasted children with inadequate or adequate fluid replacement, the respective mean ratios were 0.24, 95% CI of [0.14, 0.43], and 0.14, 95% CI of [0.09, 0.20] (F = 12.63, p less than 0.001). The fasting-associated rise was caused by increased lactulose excretion. At retesting of gastroenteritis patients after 2 days of in-hospital realimentation, the lactulose/mannitol ratios did not differ significantly from the level on admission. The study indicated that fasting maintains the increased intestinal permeability associated with acute gastroenteritis whereas early feeding at home may promote reduction of permeability and hasten recovery.