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Shiba S, Maruyama R, Kamata T, Kato D, Niwa O. Chromatographic Determination of Sugar Probes Used for Gastrointestinal Permeability Test by Employing Nickel-Copper Nanoalloy Embedded in Carbon Film Electrodes. ELECTROANAL 2018. [DOI: 10.1002/elan.201800072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Shunsuke Shiba
- Advanced Science Research Laboratory; Saitama Institute of Technology, Fusaiji, 1690, Fukaya; Saitama 369-0293 Japan
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1, Higashi, Tsukuba; Ibaraki 305-8566 Japan
- Graduate School of Pure and Applied Sciences; University of Tsukuba, 1-1-1 Tennodai, Tsukuba; Ibaraki 305-8573 Japan
| | - Rina Maruyama
- Advanced Science Research Laboratory; Saitama Institute of Technology, Fusaiji, 1690, Fukaya; Saitama 369-0293 Japan
| | - Tomoyuki Kamata
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1, Higashi, Tsukuba; Ibaraki 305-8566 Japan
| | - Dai Kato
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1, Higashi, Tsukuba; Ibaraki 305-8566 Japan
| | - Osamu Niwa
- Advanced Science Research Laboratory; Saitama Institute of Technology, Fusaiji, 1690, Fukaya; Saitama 369-0293 Japan
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Morphological and Functional Assessment of Oesophageal Mucosa Integrity in Children With Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2016; 62:757-64. [PMID: 26835909 DOI: 10.1097/mpg.0000000000001131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of the study was to investigate morphological and functional characteristics of oesophageal epithelial barrier in children with cystic fibrosis (CF) with or without gastro-oesophageal reflux disease (GORD) in comparison to healthy controls. METHODS Oesophagogastroduodenoscopy with oesophageal biopsies and combined oesophageal multichannel intraluminal impedance-pH monitoring was performed in 17 children with CF (CFtot) with (CFgord) or without GORD (CFnorm). Histological combined severity score was calculated and widths of spaces between epithelial cells were measured. Basal impedance value was used to assess functional integrity of epithelial barrier. Results of each investigation were compared with a group of children without oesophageal disease. RESULTS CFtot, but also CFnorm, had more severe pathohistological changes included in the compound severity score than controls (0.75 ± 0.32 and 0.75 ± 0.20 vs 0.27 ± 0.25; P < 0.001 and P = 0.001, respectively). They also had more dilated intercellular spaces (2.6 μm ± 0.6 and 2.7 μm ± 0.5 vs 1.9 μm ± 0.2; P = 0.001 and P < 0.001, respectively). Baseline impedance values between proximal and distal pairs of electrodes were significantly lower in CFtot (2876 Ω ± 484, 2590 Ω ± 1013) and also in CFnorm (2922 Ω ± 363, 2844 Ω ± 457) than in controls (3703 Ω ± 859, 3753 Ω ± 1070) (P = 0.012 and P = 0.002; and P = 0.027 and P = 0.005, respectively). The treatment of CFgord with proton pump inhibitor increased, but did not normalise the baseline impedance values (2860 Ω ± 560 to 3355 Ω ± 750 and 2178 Ω ± 1564 to 3057 Ω ± 594). CONCLUSIONS Children with CF had morphological and functional changes of oesophageal mucosal integrity even in the absence of GORD.
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A liquid chromatography/mass spectrometry method for the evaluation of intestinal permeability. Clin Biochem 2008; 41:887-92. [PMID: 18440311 DOI: 10.1016/j.clinbiochem.2008.03.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 02/25/2008] [Accepted: 03/29/2008] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Lactulose to mannitol ratio (L/M) in urine is used as a non invasive assay to measure intestinal permeability. We describe here a rapid, specific and sensitive LC-MS/MS method for the measurement of these compounds in urine of children affected by abdominal recurrent pain (ARP). DESIGN AND METHODS The study has been performed on 50 children from the Pediatric Unit. The chromatographic separation was accomplished by using an NH(2)-column, the detection with a Q-Trap 2000 system. RESULTS Multiple calibration curve exhibited consistent linearity and reproducibility. Linear responses were observed in the concentration range 0-400 microg/mL for both mannitol and lactulose. Limits of detection were 12.5 mg/L for lactulose and 1.25 mg/L for mannitol with a signal-to-noise ratio of 10. CONCLUSIONS The comparison of L/M values of healthy children with those found in children affected by idiopathic ARP demonstrates that in the latter subjects an alteration of intestinal permeability occurs. The method can represent a useful tool to monitor the intestinal functionality in children with ARP conditions and help for an accurate patient discrimination for diet restrictions.
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Hendriks HJ, van Kreel B, Forget PP. Effects of therapy with lansoprazole on intestinal permeability and inflammation in young cystic fibrosis patients. J Pediatr Gastroenterol Nutr 2001; 33:260-5. [PMID: 11593119 DOI: 10.1097/00005176-200109000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Defective pancreatic bicarbonate secretion with low intestinal pH or intestinal inflammation of any origin increase intestinal permeability in cystic fibrosis (CF). METHODS In this open study, the authors evaluated the effect of a proton-pump inhibitor on intestinal permeability and inflammation in 14 young, pancreatic-insufficient CF patients. Permeability was measured by a three-sugar permeability test before and after 1 year of lansoprazole use, and urinary nitric oxide (NO) oxidation products were assessed before and during that year as a marker of inflammation. RESULTS After 1 year of lansoprazole use, median urinary recovery percentages changed from 2.5% to 1.7% (P = 0.064), from 24.9% to 24.5% (no significance), and from 10.5% to 11.1% (no significance) for lactulose, mannitol, and L-rhamnose, respectively. Despite the fact that the median urinary excretion ratios decreased from 0.108 to 0.083 (P = 0.03) and from 0.246 to 0.176 (P = 0.016) for lactulose and mannitol and for lactulose and rhamnose, respectively, they both remained increased. Median urinary NO products-to-creatinine ratios were 0.287 for CF patients before lansoprazole and 0.130 for healthy control participants (P = 0.002). Although there was a tendency toward a decrease in the NO products-to-creatinine ratio during treatment, this was not significant at the end point. CONCLUSIONS Intestinal permeability is considerably increased in CF patients and is partly corrected after the use of a proton-pump inhibitor for 1 year, which may point to a harmful effect of the acid luminal contents on the tight junctional related paracellular permeability pathway. The start and end values for the NO products-to-creatinine ratio in CF patients were not significantly different, but were considerably increased when compared with control participants (P = 0.002).
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Affiliation(s)
- H J Hendriks
- Department of Paediatrics, University Hospital of Maastricht, Maastricht, The Netherlands.
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Kang SY, Go VL. Pancreatic exocrine-endocrine interrelationship. Clinical implications. Gastroenterol Clin North Am 1999; 28:551-69, viii. [PMID: 10503136 DOI: 10.1016/s0889-8553(05)70073-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The exocrine and endocrine pancreata are anatomically and functionally interrelated. As a result, exocrine pancreatic dysfunction often accompanies endocrine pancreatic dysfunction and vice versa. This article delineates the nature of these exocrine and endocrine pancreatic interrelationships and their clinical significance in the management of pancreatic disorders.
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Affiliation(s)
- S Y Kang
- University of California Los Angeles Center for Human Nutrition, USA
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Marsilio R, D’Antiga L, Zancan L, Dussini N, Zacchello F. Simultaneous HPLC determination with light-scattering detection of lactulose and mannitol in studies of intestinal permeability in pediatrics. Clin Chem 1998. [DOI: 10.1093/clinchem/44.8.1685] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
We describe a new HPLC method for the simultaneous determination of lactulose and mannitol in urine, in which cation-exchange chromatography and evaporative light-scattering detection are used. The two sugars are orally administered for the estimation of intestinal permeability in children. Samples were purified by solid phase extraction on a C18 cartridge and subsequent addition of anion-exchange resin. Cellobiose may be used as an internal standard. The chromatographic separation was carried out in 16 min at a flow rate of 0.5 mL/min, using deionized water as the mobile phase. Within-run precision (CV) measured at three concentrations was 1.6–2.3% for lactulose and 1.0–1.9% for mannitol. Between-run CVs were 2.1–4.1% and 1.3–2.7% for lactulose and mannitol, respectively. Analytical recovery of both sugar probes was 97–101%. The detection limits (signal-to-noise ratio = 3) were 0.82 mg/L for lactulose and 0.65 mg/L for mannitol. The lactulose/mannitol ratio in control subjects was 0.024 ± 0.006; in patients with Crohn’s and coeliac diseases in active phase, the ratios were 0.200 ± 0.082 and 0.072 ± 0.025, respectively. The method is rapid, simple, and sensitive, and suitable for determination of intestinal permeability in children.
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Affiliation(s)
| | | | | | | | - Franco Zacchello
- Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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Hallberg K, Grzegorczyk A, Larson G, Strandvik B. Intestinal permeability in cystic fibrosis in relation to genotype. J Pediatr Gastroenterol Nutr 1997; 25:290-5. [PMID: 9285379 DOI: 10.1097/00005176-199709000-00008] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study was to investigate whether the increase intestinal permeability (IP) seen in patients with cystic fibrosis (CF) is correlated with the basic defect, as revealed by the patient's genotype, and/or whether the intestinal disturbance reflects secondary abnormalities such as essential fatty acid deficiency. METHODS Nineteen CF patients were compared with nine age- and sex-matched healthy controls. IP was evaluated by studying urinary excretion for 5 hours after a test meal containing lactulose, L-rhamnose and xylose in water. Urine was analyzed for carbohydrates, and blood samples were taken for determination of the fatty acid pattern of serum phospholipids. The CF patients were grouped according to genotype: homozygous for delta F508, heterozygous for alpha F508, or unidentified. RESULTS Patients who were homozygous (n = 9) or heterzygous (n = 6) for delta F508 had significantly higher lactulose/L-rhamnose excretion ratios (mean(range) values of 0.08(0.05-0.13) and 0.09(0.03-0.13), respectively) than patients (n = 4) with unidentified genotypes [0.03(0.02-0.05); p = 0.005] or healthy controls [0.02(0.003-0.06); p = 0.002]. CF patients with EFAD (n = 6) did not differ from those with a normal pattern of serum phospholipid fatty acids, the lactulose/L-rhamnose excretion ratio being 0.08(0.02-0.13) and 0.07(0.03-0.12), respectively. CONCLUSIONS These data show that the IP in CF was related to patient genotype; those homozygozous or heterozygous for delta F508 having a significantly increased IP compared with patients with unidentified genotypes, who had IP values within the normal range.
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Affiliation(s)
- K Hallberg
- Department of Pediatrics, Göteborg University, Sweden
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Abstract
I reviewed the literature (1966-1994) concerning gastrointestinal (GI) pH, motility/transit, and permeability in cystic fibrosis (CF). Most studies reported were performed with very small numbers of patients, but even when considered together the published data do not confirm some generally expressed views on these topics. The only clear findings were a high incidence of gastroesophageal reflux in CF; pre- and postprandial duodenal pH is 1-2 U lower in patients with CF than in healthy controls; and small intestinal paracellular permeability is 4-10 times greater than normal in CF. Some patients showed abnormalities of lower esophageal sphincter pressure and of esophageal motility, but apart from one case study other disturbances of GI motility have not been reported. The results of hydrogen breath tests strongly suggest that oro-cecal transit is slowed in CF, but these results must be confirmed by an alternative test. Measurements of colonic transit and colonic permeability have not been reported. The few studies of gastric emptying reported are controversial. Whether GI pH, apart from duodenal pH, is normal in CF or whether a subset of patients has exceptionally acid intestinal contents requiring specialized pancreatic enzyme supplementation to normalize digestion is not clear. Finally, I briefly discuss the findings in relation to their possible impact on the pathogenesis of fibrosing colonopathy.
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Affiliation(s)
- P C Gregory
- Department of Gastrointestinal Pharmacology, Solvay Pharma Deutschland, Hannover, Germany
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van Elburg RM, Uil JJ, van Aalderen WM, Mulder CJ, Heymans HS. Intestinal permeability in exocrine pancreatic insufficiency due to cystic fibrosis or chronic pancreatitis. Pediatr Res 1996; 39:985-91. [PMID: 8725259 DOI: 10.1203/00006450-199606000-00010] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Disturbances of the intestinal integrity, reflected by an increased intestinal permeability, are reported in cystic fibrosis (CF). Controversy exists whether the increased intestinal permeability is due to CF itself or a consequence of the concomitant exocrine pancreatic insufficiency (PI). We measured intestinal permeability by the sugar absorption test in 32 PI patients: 20 CF-PI, 12 nonCF-PI with chronic pancreatitis, and 50 controls. In the sugar absorption test, the lactulose/mannitol ratio is measured in 5-h urine samples after oral ingestion of a solution of lactulose and mannitol, hyperosmolar by the addition of sucrose. The lactulose/mannitol ratio was increased in both CF-PI and nonCF-PI versus controls (p < 0.0001). In CF, the L/M ratio and permeability for lactulose and mannitol did not change by increasing pancreatic enzyme supplementation by 30-50% for 2 wk (p = 0.74, p = 0.97, p = 0.74, respectively) nor by decreasing the osmolarity of the test solution by 75% (p = 0.24, p = 0.10, p = 0.39, respectively). We conclude that an increased intestinal permeability in CF is probably a consequence of PI and is not related to the dose of pancreatic enzyme supplementation nor the osmolarity of the test solution. The increase is due to an increased permeability for lactulose which might point toward a defect in the tight junctions of the villi and/or crypts. The cause of the increased intestinal permeability in the presence of PI is still unclear. An increased intestinal permeability points toward an impaired functional integrity of the small bowel, which may contribute to gastrointestinal dysfunction in CF.
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Affiliation(s)
- R M van Elburg
- Beatrix Children's Hospital, University Hospital Groningen, The Netherlands
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Affiliation(s)
- M R Green
- Children's Hospital, Leicester Royal Infirmary
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Bowler IM, Green JH, Wolfe SP, Littlewood JM. Resting energy expenditure and substrate oxidation rates in cystic fibrosis. Arch Dis Child 1993; 68:754-9. [PMID: 8333766 PMCID: PMC1029368 DOI: 10.1136/adc.68.6.754] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The resting energy expenditure (REE) and substrate oxidation rates in 16 patients with cystic fibrosis who had mild chest disease and 11 healthy controls were measured using indirect calorimetry. The mean REE (% predicted) in the patients with cystic fibrosis was 11% greater than in the controls. Five patients with cystic fibrosis were hypermetabolic but only one of these had a clinically significant reduction of respiratory function. A greater proportion of REE was derived from carbohydrate oxidation in the cystic fibrosis patients (43.5% v 29.9%). However, the 24 hour dietary intake of carbohydrate was greater in the cystic fibrosis group (49.6 v 45.8% of energy intake). These data suggest that a high dietary intake of carbohydrate may contribute to the increased oxidation of carbohydrate in these cystic fibrosis patients. All patients with cystic fibrosis, including those with apparently mild lung disease, should continue to receive a high energy diet.
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Affiliation(s)
- I M Bowler
- Regional Cystic Fibrosis Unit, St James's University Hospital, Leeds
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Abstract
There is a pressing need for a simple non-invasive test of exocrine pancreatic function for use in children. The pancreolauryl test has been modified by the addition of a second marker (mannitol) to achieve a single day test without the need for two timed urine collections. Six healthy subjects and nine patients with cystic fibrosis were studied. Fluorescein, fluorescein dilaurate, and mannitol were taken by mouth, alone or in combinations, followed by 10 hour urine collections in two hourly aliquots to study the comparative pharmacokinetics of these markers. Urinary fluorescein was determined spectrophotometrically and urinary mannitol enzymatically. When fluorescein dilaurate and mannitol were taken together and the results expressed as ratios of percentage fluorescein to percentage mannitol recovery (F:M ratio) (mean (SD)) there was clear discrimination between healthy subjects and those with cystic fibrosis regardless of enzyme replacement treatment (57.3 (18.2) v 3.4 (1.4) v 3.2 (1.6) respectively). The differences in F:M ratios reached statistical significance in urinary aliquots collected between two and eight hours after marker ingestion. This single day tubeless test will greatly simplify the investigation of the child with suspected exocrine pancreatic dysfunction.
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Affiliation(s)
- M Cipolli
- Cystic Fibrosis Center, Ospedale Civile Maggiore, Verona, Italy
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Mack DR, Flick JA, Durie PR, Rosenstein BJ, Ellis LE, Perman JA. Correlation of intestinal lactulose permeability with exocrine pancreatic dysfunction. J Pediatr 1992; 120:696-701. [PMID: 1578303 DOI: 10.1016/s0022-3476(05)80230-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Increased intestinal permeability to lactulose has been reported in patients with cystic fibrosis (CF). To determine whether this finding is unique to CF or whether it is related to accompanying exocrine pancreatic dysfunction, we evaluated 31 patients with CF and 10 with Shwachman syndrome who had variable degrees of pancreatic dysfunction, together with 17 healthy control subjects. There was no significant difference in the mean urinary lactulose excretion, expressed as the percentage of dose recovered, between CF and non-CF patients with pancreatic insufficiency (2.1% +/- 1.2% and 1.9% +/- 0.8, respectively) or between CF and non-CF patients with pancreatic sufficiency (0.6% +/- 0.5% and 0.6% +/- 0.3%, respectively). However, there was a significant difference in mean lactulose excretion between the pancreatic-insufficient and the pancreatic-sufficient patients (both CF and non-CF groups; p less than 0.001 and p less than 0.013, respectively). We further analyzed the results from 26 of the 41 patients (16 patients with CF and 10 non-CF patients) with pancreatic dysfunction who had previously undergone quantitative pancreatic function testing. A nonlinear, inverse relationship was found between urinary lactulose excretion and exocrine pancreatic function determined by duodenal trypsin output. These data confirm a direct relationship between intestinal lactulose permeability and the degree of exocrine pancreatic dysfunction, unrelated to the cause of the pancreatic disease.
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Affiliation(s)
- D R Mack
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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van Elburg RM, Uil JJ, de Monchy JG, Heymans HS. Intestinal permeability in pediatric gastroenterology. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1992; 194:19-24. [PMID: 1298042 DOI: 10.3109/00365529209096021] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The role of the physiologic barrier function of the small bowel and its possible role in health and disease has attracted much attention over the past decade. The intestinal mucosal barrier for luminal macromolecules and microorganism is the result of non-immunologic and immunologic defense mechanisms. The non-immunologic mechanisms consist of intraluminal factors such as gastric acid, proteolytic activity, and motility and of mucosal surface factors like mucin and the microvillous membrane. The immunologic mechanisms include secretary IgA and cell-mediated immunity. Both types of mechanism are not completely mature at birth. Maturation of this barrier is not finished before the 2nd year of life. One of the aspects of the mucosal barrier function can be estimated by the intestinal permeability (IP) for macromolecules. We use the differential sugar absorption test (SAT), in which the ratio of urinary excretion of a relatively large molecule, lactulose, is compared with that of a relatively small molecule, mannitol, after oral ingestion. Although the small intestine is permeable to certain macromolecules in normal developmental conditions, an increased IP could be involved in the pathophysiology of several diseases, including infectious diarrhea, food allergy, celiac disease, and Crohn's disease. It can be concluded that IP, as measured with the SAT, reflects the state of the mucosal barrier and is altered in several gastrointestinal diseases. The SAT is a non-invasive IP test that can be of diagnostic help to demonstrate alterations in the small-mucosal barrier function and may be useful to evaluate therapeutic interventions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R M van Elburg
- Dept. of Pediatrics and Allergology, University Hospital, Groningen, The Netherlands
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