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Updated: Apr 11, 2026
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Published on: February 11, 2021
Intestinal permeability in children with recurrent respiratory and gastrointestinal symptoms
Mario Barreto1, Melania Evangelisti1, Luigi Principessa1
1Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy.
Insights
Increased intestinal permeability is linked to gastrointestinal symptoms, not respiratory ones, in children with asthma or functional gastrointestinal disorders (FGIDs). This suggests gut health impacts FGIDs more than airway inflammation affects gut permeability.
Area of Science:
- Pediatric Gastroenterology
- Pulmonology
- Immunology
Background:
- Increased intestinal permeability is observed in asthma and gastrointestinal diseases, implicating the mucosal immune system.
- The relationship between intestinal permeability and symptoms in pediatric asthma and functional gastrointestinal disorders (FGIDs) requires further investigation.
Purpose of the Study:
- To assess intestinal permeability in children with asthma and FGIDs.
- To correlate intestinal permeability with recurrent respiratory and gastrointestinal symptoms in these pediatric populations.
Main Methods:
- Evaluated 108 outpatients (ages 3-14) with asthma or FGIDs.
- Measured urinary lactulose/mannitol (L/M) ratio via liquid chromatography-mass spectrometry.
- Administered questionnaires for symptoms and performed allergy skin prick tests.
Main Results:
- Higher L/M ratios (indicating increased permeability) were less common in asthmatic children (20%) compared to those with FGIDs (65%).
- Elevated L/M ratios strongly correlated with gastrointestinal symptoms in both groups.
- Intestinal permeability was not associated with respiratory symptoms or atopy; absence of asthma and presence of GI symptoms predicted high L/M ratio.
Conclusions:
- Increased intestinal permeability is primarily associated with recurrent gastrointestinal symptoms in children, irrespective of asthma or FGID diagnosis.
- The findings do not support a direct link between respiratory inflammation and increased intestinal permeability in this cohort.
Aim:
Increased intestinal permeability has been reported in asthmatic subjects as well as in patients with gastrointestinal disease, thus suggesting the involvement of all the mucosal immune system. We aimed to assess intestinal permeability according to recurrent respiratory and gastrointestinal symptoms in children with asthma and children with functional gastrointestinal disorders (FGIDs).
Methods:
In 108 outpatients aged 3-14 years (45 asthmatic, 63 with FGIDs), we measured the urinary lactulose/mannitol (L/M) ratio, performed allergy skin prick tests and administered questionnaires for recurrent respiratory and gastrointestinal symptoms starting from at least 2 months which persisted over the previous 4 weeks. L/M ratios were compared with previously reported normal values yielded by our chromatographic method (liquid chromatography-mass spectrometry).
Results:
High L/M ratios (>0.030) were less frequent in asthmatic children than in children with FGIDs (9/45: 20% vs. 41/63: 65%, P < 0.001). High L/M ratios were associated with gastrointestinal symptoms in 8/9 asthmatic (P < 0.05) and 39/41 subjects with FGIDs (P < 0.005). L/M ratios were not associated with respiratory symptoms or atopy. In a regression model, a high L/M was predicted by low height, absence of asthma and presence of gastrointestinal symptoms (r = 0.72, P < 0.001).
Conclusions:
Increased intestinal permeability is associated with recurrent gastrointestinal symptoms rather than with recurrent respiratory symptoms in both asthmatic children and those with FGIDs. Our findings do not support the hypothesis of mucosal intestinal damage following an inflammatory stimulus in the respiratory mucosa.
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