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Intestinal permeability assessed with different-sized polyethylene glycols in children undergoing small-intestinal
K Fälth-Magnusson1, G Jansson, L Stenhammar
1Dept. of Pediatrics, University of Linköping, Sweden.
Insights
Children with suspected celiac disease showed altered intestinal permeability, indicated by polyethylene glycol (PEG) test results. PEG testing can help determine optimal timing for small-intestinal biopsy in pediatric gluten intolerance.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Physiology
- Celiac Disease Diagnostics
Background:
- Assessing gastrointestinal permeability is crucial for diagnosing conditions like celiac disease.
- Small-intestinal biopsy is a standard diagnostic tool, but its timing can be challenging.
- Polyethylene glycols (PEGs) of varying sizes offer a non-invasive method to evaluate intestinal barrier function.
Purpose of the Study:
- To investigate the utility of differential-sized polyethylene glycol (PEG) testing in assessing gastrointestinal permeability in children with suspected celiac disease.
- To correlate PEG test results with mucosal abnormalities found during small-intestinal biopsy.
- To evaluate the impact of gluten elimination and challenge on PEG recovery in children.
Main Methods:
- An oral load of PEG 400 and PEG 1000 was administered to 76 children undergoing small-intestinal biopsy.
- Urinary recovery of different-sized PEG molecules was measured.
- The ratio of recovery between large (1074 Da) and small (370 Da) PEG molecules was analyzed.
- Repeated PEG tests were performed after gluten withdrawal and challenge in some children.
Main Results:
- Children with mucosal abnormalities suggestive of celiac disease exhibited lower urinary recovery of larger PEG molecules.
- An altered permeability barrier was indicated by a reduced ratio of large to small PEG molecule recovery.
- Gluten elimination and challenge significantly altered PEG recoveries in children undergoing repeated testing.
Conclusions:
- Differential-sized PEG testing can effectively assess gastrointestinal permeability in children with suspected celiac disease.
- PEG test results correlate with biopsy findings and can reflect changes due to gluten intake.
- Repeated PEG assessments following gluten withdrawal and challenge may complement or guide the timing of small-intestinal biopsy in pediatric gluten intolerance.
Abstract:
The gastrointestinal permeability was assessed by means of an oral load of a mixture of different-sized polyethylene glycols (PEG 400 and PEG 1000) in 76 children undergoing small-intestinal biopsy because of suspected celiac disease. Children with a mucosal abnormality suggestive of celiac disease had a lower urinary recovery of larger PEG molecules. They also displayed an altered permeability barrier, as evidenced by a lower ratio of recovery between large (1074 Da) and small (370 Da) PEG molecules. Gluten elimination and gluten challenge caused a significant change in PEG recoveries in children undergoing repeated PEG tests. Repeated assessments of intestinal permeability by means of different-sized PEGs after gluten withdrawal and challenge could complement or indicate suitable time for performing small-intestinal biopsy in children with gluten intolerance.