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Intestinal permeability assessed with polyethylene glycols in children with diarrhea due to rotavirus and common
K Johansen1, G Stintzing, K E Magnusson
1Department of Pediatrics, Karolinska Institute, Stockholm, Sweden.
Insights
Children with acute diarrhea showed reduced polyethylene glycol (PEG) absorption. Rotavirus infection caused more severe intestinal damage than other pathogens, impacting PEG excretion differently based on pathogen type.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Gastrointestinal Physiology
Background:
- Intestinal permeability is a key indicator of gut health.
- Acute diarrhea in children can significantly alter intestinal barrier function.
- Understanding etiology-specific effects on permeability is crucial for targeted treatment.
Purpose of the Study:
- To assess intestinal permeability in children with acute diarrhea using polyethylene glycols (PEGs).
- To investigate differences in PEG absorption and excretion based on the causative pathogen and nutritional status.
- To determine if specific infections cause distinct changes in the intestinal mucosal barrier.
Main Methods:
- Assessment of intestinal permeability using different molecular sizes of polyethylene glycols (PEG 400 and PEG 1,000).
- Measurement of PEG absorption and excretion in urine of children with acute diarrhea and healthy controls.
- Analysis of PEG recovery ratios to evaluate relative permeability to large versus small molecules.
Main Results:
- Children with acute diarrhea exhibited significantly reduced PEG absorption and excretion compared to healthy controls.
- Rotavirus infections showed significantly lower PEG excretion than Shigella, Salmonella, and enteropathogenic E. coli (EPEC) infections.
- Severe malnutrition was associated with decreased PEG absorption, particularly in rotavirus cases.
- Shigella and EPEC infections indicated increased relative permeability to larger molecules, while rotavirus and Salmonella showed decreased relative permeability.
Conclusions:
- Intestinal permeability is significantly impaired in children with acute diarrhea.
- Rotavirus infection appears to cause more severe mucosal lesions than other common enteric pathogens.
- Malnutrition exacerbates the impairment of intestinal barrier function in diarrheal illnesses.
- Enteric pathogen type influences intestinal permeability characteristics, suggesting etiology-specific mucosal damage.
Abstract:
Intestinal permeability was assessed with different-sized polyethylene glycols (PEG 400 and PEG 1,000) in small children with acute diarrhea. All children with acute diarrhea absorbed and excreted less PEG of all molecular sizes into the urine when compared with healthy control children (p less than 0.001). Children with acute rotavirus infection excreted significantly less PEG of all sizes than children with Shigella, Salmonella, and enteropathogenic Escherichia coli (EPEC) infection (p less than 0.001-0.01), suggesting a more severe mucosal lesion caused by rotavirus. In patients with severe malnutrition there was also a significant decrease in absorption of PEGs observed. In addition, malnourished patients with rotavirus diarrhea showed a pronounced decrease of PEGs in comparison with well-nourished patients. The ratio between the recovery of a large PEG molecule, 1,074 Da, and a small molecule, 370 Da, was utilized to assess the absorption of large molecules in relation to that of smaller ones. On applying this ratio, it was noted that the intestine in children with Shigella and EPEC infection was relatively more permeable to larger molecules than in healthy controls, while in rotavirus and Salmonella infection it was less permeable to larger molecules. In this study significant differences in the permeability characteristics were observed, suggesting etiology-specific effects on the mucosal barrier.