Intestinal permeability and the prediction of relapse in Crohn's disease

J Wyatt, H Vogelsang, W Hübl, T Waldhoer, H Lochs - The Lancet, 1993 - Elsevier
J Wyatt, H Vogelsang, W Hübl, T Waldhoer, H Lochs
The Lancet, 1993Elsevier
To see whether intestinal permeability (IP) predicted relapse in Crohn's disease, we
measured IP in 72 patients with quiescent Crohn's disease using the lactulose-mannitol test.
The permeability index (lactulose/mannitol) was significantly higher in patients than in
controls (0· 046 [SEM 0· 005] vs 0· 018 [SEM 0· 002], respectively). Patients were followed
for 1 year after the test. 26 of the 37 patients with raised permeability, but only 6 of the 35
with normal permeability relapsed within 1 year after the test (p< 0· 001). The sensitivity of …
Abstract
To see whether intestinal permeability (IP) predicted relapse in Crohn's disease, we measured IP in 72 patients with quiescent Crohn's disease using the lactulose-mannitol test. The permeability index (lactulose/mannitol) was significantly higher in patients than in controls (0·046 [SEM 0·005] vs 0·018 [SEM 0·002], respectively). Patients were followed for 1 year after the test. 26 of the 37 patients with raised permeability, but only 6 of the 35 with normal permeability relapsed within 1 year after the test (p<0·001). The sensitivity of the permeability test as a predictor for relapse was 81 %. A significant correlation was found between the value of the permeability index and the probability of relapse (p<0·01). These results show that increases in intestinal permeability precede clinical relapses in Crohn's disease and so are an indicator of subclinical disease. The measurement of intestinal permeability may lead to a better understanding of the pathogenesis of Crohn's disease.
Elsevier