Rapid gas-chromatographic assay of lactulose and mannitol for estimating intestinal permeability

We developed a gas-chromatographic method to determine urinary mannitol and lactulose. The procedure for purification of urine by a resin was optimized for purification of analytes and high recovery; the aliquot of resin chosen (500 mg) was kept in contact with the urine for 1 min. The recoveries of mannitol and lactulose were > 85% at concentrations that include both normal and pathological values. Sugars were converted to oximes before the silylation step to avoid multiple peaks for the anomeric forms. The calibration was linear over the range 0.1-1 microgram of sugar injected. Analytical recovery of the sugars ranged from 90% to 95.3% for mannitol and from 90.4% to 95.8% for lactulose. The mean within-day imprecision (CV) was 6.2% for mannitol and 4.7% for lactulose; the between-day CV was 6.7% for mannitol and 5.1% for lactulose. A lactulose/mannitol ratio of 0.035 completely differentiated 28 normal children and 28 children with active gluten-sensitive enteropathy, whose mean ratios were 0.022 (SD 0.007) and 0.084 (SD 0.054), respectively.