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[Increased intestinal permeability to 51 Cr-EDTA among children with persistent diarrhea]
R Sawamura1, M I Fernandes, L E Troncon
1Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP).
Insights
Children with persistent diarrhea exhibit increased intestinal permeability, as measured by the 51Cr-EDTA test. This heightened permeability may contribute to malabsorption and malnutrition, but normalizes after recovery, indicating its role in the condition's cycle.
Area of Science:
- Gastroenterology
- Pediatrics
- Clinical Nutrition
Context:
- Persistent diarrhea is a significant health issue in developing nations, leading to intestinal mucosal damage and increased permeability.
- Altered intestinal permeability is implicated in the cycle of diarrhea, malabsorption, and malnutrition in children.
- The 51Cr-EDTA test is a validated method for assessing intestinal permeability.
Purpose:
- To investigate intestinal permeability using the 51Cr-EDTA test in Brazilian children suffering from persistent diarrhea.
- To compare intestinal permeability between children with persistent diarrhea and healthy controls.
- To evaluate the correlation between diet (protein hydrolysate/total parenteral nutrition) and intestinal permeability in these patients.
Summary:
- The study found significantly higher 51Cr-EDTA excretion in children with persistent diarrhea compared to controls, indicating increased intestinal permeability.
- Approximately 61.5% of children with persistent diarrhea showed abnormal intestinal permeability results.
- Intestinal permeability improved in patients after clinical recovery, suggesting it's a secondary phenomenon reversible with healing.
Impact:
- The 51Cr-EDTA test can serve as a valuable indicator of persistent diarrhea severity.
- Findings suggest that increased intestinal permeability in persistent diarrhea may facilitate antigen entry, potentially leading to allergic enteropathy and perpetuating the condition.
- Restoration of intestinal barrier function is crucial for recovery, highlighting the importance of nutritional support and treatment strategies.
Abstract:
Persistent diarrhea, a condition highly prevalent in developing countries, causes different morphological and functional alterations of the mucosa of the small intestine, including increased permeability to different test molecules. In the present study we investigate for the first time the intestinal permeability to 51Cr-EDTA of Brazilian children with persistent diarrhea. The test of 51Cr-EDTA absorption was performed in 13 control children and in 14 children with persistent diarrhea by offering 50 microCi of the test substance by the oral route, with later detection of radioactivity excreted in 24-hour urine. There was a statistically significant difference between the control group (median = 1.26; range = 0.20-3.31%) and the group with persistent diarrhea (median = 4.68; range = 1.40-10.29%). Using the minimum and maximum values detected in the control group as the normal reference standard for the test of urinary 51Cr-EDTA absorption, we observed that 61.5% of the patients with persistent diarrhea showed altered results. Among the patients with persistent diarrhea, 51Cr-EDTA excretion was significantly higher in the group fed a protein hydrolysate diet and/or total parenteral nutrition than in the group that did not receive this diet. In four patients with persistent diarrhea, the test was performed after clinical recovery, with a fall in the excretion levels in all cases. On the basis of these data, we may conclude that: 1) in persistent diarrhea there must be alteration of intestinal permeability that might permit an increased entry of local alimentary antigens, with subsequent sensitization and allergic enteropathy, contributing to the perpetuation of the diarrhea, malabsorption and malnutrition cycle; 2) the 51Cr-EDTA test may be useful as an indicator of severity in persistent diarrhea; 3) alteration of intestinal permeability is a secondary phenomenon in persistent diarrhea, with normalization occurring after reconstruction of the intestinal barrier.