Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1988 Sep;63(9):1054–1059. doi: 10.1136/adc.63.9.1054

Urinary mannitol: lactulose excretion ratios and jejunal mucosal structure.

K A Nathavitharana 1, D R Lloyd 1, F Raafat 1, G A Brown 1, A S McNeish 1
PMCID: PMC1779104  PMID: 3140738

Abstract

A dual sugar (mannitol, lactulose) absorption test was evaluated using an iso-osmolar oral dose in two groups of children: a study group of 43 children divided into five subgroups, based on severity of mucosal damage, and a control group of 53 children with histologically normal jejunal biopsy specimens. After an oral dose, the three hour urinary mannitol: lactulose ratios in the control group showed a highly significant positive correlation with body surface area. After correction for the body surface area relationship, a control lower limit was defined by the mean -2SD of the log10 transformed control mannitol: lactulose ratios. Specificity and sensitivity for severe villous atrophy was 98% and 95% respectively but the sensitivity declined rapidly with decreasing degrees of mucosal damage, and the test would not therefore be an adequate screening procedure for all enteropathies. In sequential studies in 18 children, the changes in the mannitol: lactulose ratio were consistent with the changes in mucosal structure induced by gluten challenge or gluten withdrawal. The test may therefore have a role in any sequential study of lesions of the mucosa of the small intestine.

Full text

PDF
1059

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Behrens R. H., Lunn P. G., Northrop C. A., Hanlon P. W., Neale G. Factors affecting the integrity of the intestinal mucosa of Gambian children. Am J Clin Nutr. 1987 Jun;45(6):1433–1441. doi: 10.1093/ajcn/45.6.1433. [DOI] [PubMed] [Google Scholar]
  2. Clarke E. A., Anderson T. W. Does screening by "Pap" smears help prevent cervical cancer? A case-control study. Lancet. 1979 Jul 7;2(8132):1–4. doi: 10.1016/s0140-6736(79)90172-7. [DOI] [PubMed] [Google Scholar]
  3. Cobden I., Rothwell J., Axon A. T. Intestinal permeability and screening tests for coeliac disease. Gut. 1980 Jun;21(6):512–518. doi: 10.1136/gut.21.6.512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cobden I., Rothwell J., Axon A. T. Non-invasive test for small-intestinal mucosal damage. Lancet. 1979 Dec 22;2(8156-8157):1379–1379. doi: 10.1016/s0140-6736(79)92871-x. [DOI] [PubMed] [Google Scholar]
  5. Ford R. P., Menzies I. S., Phillips A. D., Walker-Smith J. A., Turner M. W. Intestinal sugar permeability: relationship to diarrhoeal disease and small bowel morphology. J Pediatr Gastroenterol Nutr. 1985 Aug;4(4):568–574. [PubMed] [Google Scholar]
  6. HUBBLE D., LITTLEJOHN S. THE D-XYLOSE EXCRETION TEST IN COELIAC DISEASE IN CHILDHOOD. Arch Dis Child. 1963 Oct;38:476–480. doi: 10.1136/adc.38.201.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hamilton I., Hill A., Bose B., Bouchier I. A., Forsyth J. S. Small intestinal permeability in pediatric clinical practice. J Pediatr Gastroenterol Nutr. 1987 Sep-Oct;6(5):697–701. doi: 10.1097/00005176-198709000-00006. [DOI] [PubMed] [Google Scholar]
  8. Laker M. F., Bull H. J., Menzies I. S. Evaluation of mannitol for use as a probe marker of gastrointestinal permeability in man. Eur J Clin Invest. 1982 Dec;12(6):485–491. doi: 10.1111/j.1365-2362.1982.tb02230.x. [DOI] [PubMed] [Google Scholar]
  9. Laker M. F., Menzies I. S. Increase in human intestinal permeability following ingestion of hypertonic solutions. J Physiol. 1977 Mar;265(3):881–894. doi: 10.1113/jphysiol.1977.sp011750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Lamabadusuriya S. P., Packer S., Harries J. T. Limitations of xylose tolerance test as a screening procedure in childhood coeliac disease. Arch Dis Child. 1975 Jan;50(1):34–39. doi: 10.1136/adc.50.1.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Leclercq-Foucart J., Forget P. P., Van Cutsem J. L. Lactulose-rhamnose intestinal permeability in children with cystic fibrosis. J Pediatr Gastroenterol Nutr. 1987 Jan-Feb;6(1):66–70. doi: 10.1097/00005176-198701000-00012. [DOI] [PubMed] [Google Scholar]
  12. Lifschitz C. Intestinal permeability. J Pediatr Gastroenterol Nutr. 1985 Aug;4(4):520–522. doi: 10.1097/00005176-198508000-00003. [DOI] [PubMed] [Google Scholar]
  13. Nasrallah S. M., Iber F. L. Mannitol absorption and metabolism in man. Am J Med Sci. 1969 Aug;258(2):80–88. doi: 10.1097/00000441-196908000-00003. [DOI] [PubMed] [Google Scholar]
  14. Pearson A. D., Craft A. W., Pledger J. V., Eastham E. J., Laker M. F., Pearson G. L. Small bowel function in acute lymphoblastic leukaemia. Arch Dis Child. 1984 May;59(5):460–465. doi: 10.1136/adc.59.5.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pearson A. D., Eastham E. J., Laker M. F., Craft A. W., Nelson R. Intestinal permeability in children with Crohn's disease and coeliac disease. Br Med J (Clin Res Ed) 1982 Jul 3;285(6334):20–21. doi: 10.1136/bmj.285.6334.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Weaver L. T., Chapman P. D., Madeley C. R., Laker M. F., Nelson R. Intestinal permeability changes and excretion of micro-organisms in stools of infants with diarrhoea and vomiting. Arch Dis Child. 1985 Apr;60(4):326–332. doi: 10.1136/adc.60.4.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Weaver L. T., Laker M. F., Nelson R. Intestinal permeability in the newborn. Arch Dis Child. 1984 Mar;59(3):236–241. doi: 10.1136/adc.59.3.236. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES