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Duodenal morphometry and small bowel permeability in children with portal hypertension
Vibhor V Borkar1, Ujjal Poddar, Niraj Kumari
1*Department of Pediatric Gastroenterology †Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences ‡Centre of Biomedical Research, Lucknow, India.
Insights
Portal hypertension (PHT) in children is linked to duodenopathy and increased small intestinal permeability (SIP). However, these factors, along with undernutrition, do not correlate in childhood PHT.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Gastrointestinal Physiology
Background:
- Portal hypertension (PHT) in children can lead to duodenal structural changes and impaired intestinal barrier function.
- Understanding the relationship between PHT, duodenopathy, small intestinal permeability (SIP), and nutritional status is crucial for effective management.
Purpose of the Study:
- To define histopathological parameters of portal hypertensive duodenopathy (PHTD) in children.
- To investigate the presence and extent of SIP in children with PHT.
- To determine associations between structural duodenal changes, SIP, and nutritional status in pediatric PHT.
Main Methods:
- Prospective study of 31 children with PHT (cirrhosis or extrahepatic portal venous obstruction) and 15 healthy controls.
- SIP assessed using lactulose and mannitol probes.
- Duodenal biopsies analyzed for morphometric parameters; correlated with nutritional status and dietary intake.
Main Results:
- 48% of children with PHT exhibited PHTD, characterized by villous atrophy, dilated capillaries, and thickened muscularis mucosae.
- Increased lactulose excretion in PHT patients indicated heightened paracellular permeability (SIP).
- Children with PHT showed significantly lower anthropometric z-scores, but dietary intake was similar to controls. No correlation found between SIP, nutritional compromise, and PHTD.
Conclusions:
- Portal hypertensive duodenopathy is a common finding in children with PHT.
- Increased small intestinal permeability in PHT is primarily due to enhanced paracellular pathways.
- SIP, undernutrition, and PHTD are independent factors in childhood PHT and do not show inter-correlation.
Objective:
We prospectively studied children with portal hypertension (PHT) for portal hypertensive duodenopathy (PHTD) and small bowel intestinal permeability (SIP) with the objectives of defining histopathological parameters for PHTD and to find out whether any association existed among structural changes, SIP, and nutritional status.
Method:
SIP was assessed by using lactulose and mannitol sugar probes in 31 children with PHT (cirrhosis n = 15 and extrahepatic portal venous obstruction n = 16) and 15 healthy children as controls. Morphometric assessment from duodenal biopsies was done in children with PHT. SIP and morphometric parameters were correlated with nutritional status and dietary intake.
Results:
Among children with PHT, 48% had PHTD defined as presence of villous atrophy (villous to crypt ratio < 2.5:1), dilated capillaries (capillary diameter > 16.8 μm, capillary area > 151 μm, capillary perimeter > 56 μm), and thickened muscularis mucosae (>22.2 μm). Lactulose excretion alone was increased in children with PHT as compared with healthy children (median %: 0.03, 0.02, and 0.01 for cirrhosis, extrahepatic portal venous obstruction, and controls, respectively [P < 0.01]) signifying increased paracellular permeability in PHT. Children with PHT had significantly lower z scores for height, weight, and triceps skin-fold thickness (<-2SD), whereas no differences were found in dietary intake between patients and controls. Increased SIP, nutritional compromise, and PHTD in our patients had no correlation.
Conclusions:
PHT is often associated with duodenopathy. SIP does occur as a result of increased paracellular permeability. Factors of increased SIP, undernutrition, and PHTD do not have correlation in childhood PHT.
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