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Small intestinal permeability is increased in diarrhea predominant IBS

Small intestinal permeability is increased in diarrhoea predominant IBS, while alterations in gastroduodenal permeability in all IBS subtypes are largely attributable to confounders, reports August's issue of the Alimentary Pharmacology & Therapeutics.

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Intestinal permeability has been studied in small groups of IBS patients with contrasting findings.

Professor Masclee and colleagues from the Netheralands assessed intestinal permeability at different sites of the GI tract in different subtypes of well-characterized IBS patients and healthy controls.

The research team assessed potential confounding factors.

IBS patients and healthy controls underwent a multi-sugar test to assess site-specific intestinal permeability.

Sucrose excretion and lactulose/rhamnose ratio in 0–5 hour urine indicated gastroduodenal and small intestinal permeability, respectively.

Urinary sucrose excretion was significantly increased in the total IBS group
Alimentary Pharmacology & Therapeutics

Sucralose/erythritol ratio in 0–24 hour, and 5–24 hour urine indicated whole gut and colonic permeability, respectively.

Linear regression analysis was used to assess the association between IBS groups and intestinal permeability, and to adjust for age, sex, BMI, anxiety or depression, smoking, alcohol intake and use of medication.

The team enrolled 91 IBS patients, and 94 healthy controls.

The research team found that urinary sucrose excretion was significantly increased in the total IBS group, as well as in IBS-C and IBS-D vs. healthy controls.

However, differences attenuated when adjusting for confounders.

The team observed that the lactulose/rhamnose ratio was increased in IBS-D vs. healthy controls, which remained significant after adjustment for confounders.

No difference was found in 0–24 and 5–24 hours sucralose/erythritol ratio between groups.

Professor Masclee's team concludes, "Small intestinal permeability is increased in patients with IBS-D compared to healthy controls, irrespective of confounding factors."

"Adjustment for confounders is necessary when studying intestinal permeability, especially in a heterogeneous disorder such as IBS."

Aliment Pharmacol Ther 2014: 40(3): 288–297
17 July 2014

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