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[Intestinal permeability in the first year of life. The effect of diarrhea]
M Gotteland1, S Cruchet Muñoz, M Araya Quezada
1Unidad de Gastroenterología, Universidad de Chile, Santiago, Chile.
Insights
Intestinal permeability in infants decreases with age, as shown by lower lactulose excretion. Diarrhea temporarily increases this permeability, indicating gut barrier damage.
Area of Science:
- Gastroenterology
- Pediatric Nutrition
- Intestinal Physiology
Context:
- The intestinal barrier's development is crucial for infant health.
- Assessing intestinal permeability provides insights into gut maturation and disease.
- Longitudinal studies are vital for understanding developmental changes in infants.
Purpose:
- To longitudinally assess intestinal permeability in infants using lactulose and mannitol excretion.
- To evaluate the impact of diarrhea episodes on intestinal permeability in infants.
- To correlate changes in permeability with infant age and gastrointestinal health.
Summary:
- Lactulose excretion significantly decreased in infants from 1 to 11-12 months, suggesting intestinal barrier maturation.
- Mannitol excretion showed a non-significant trend of decrease, while the lactulose/mannitol ratio remained stable.
- Diarrhea episodes were associated with a marked increase in the lactulose/mannitol ratio, primarily due to elevated lactulose excretion.
Impact:
- Findings suggest that reduced lactulose excretion reflects normal intestinal barrier maturation in infants.
- Diarrhea episodes transiently compromise the intestinal barrier, highlighting its vulnerability to infection or inflammation.
- This study provides valuable data for understanding infant gut health and the effects of common pediatric illnesses.
Objective:
The permeability of the intestinal mucosa to lactulose and mannitol was explored longitudinally in infants at 1, 3-4 and 11-12 months of age. This was also evaluated during the episodes of diarrhea that they suffered during follow-up.
Patients And Methods:
Sugar excretion was measured by gas chromatography in five-hour urine samples.
Results:
A decrease in lactulose excretion was observed, which became significant at 11-12 months of age (p = 0.02). No changes were detected in mannitol excretion, although this showed a tendency to decrease. The lactulose/mannitol (L/M) ratio remained unchanged. During the 15 episodes of diarrhea observed in these infants during the 12 month follow-up, a considerable increase in this ratio was seen, due mainly to increased lactulose excretion.
Conclusions:
It is hypothesized that the decrease in lactulose excretion between one and 11-12 months of age is part of the maturational process of the intestinal barrier, while diarrhea results in increased permeability due to damage to the absorptive epithelium.