Influence of urine volume on the assessment of intestinal permeability in affected children by multiple sugar probes
-
Riccardo Addobbati
, Nicola Di Toro
Abstract
Background: In this study we have looked at the reliability of a multi-sugar test in a pediatric patient population and its accuracy at small urine volumes to evaluate intestinal permeability.
Methods: Out of 117 subjects enrolled, 31 were healthy and 86 were sick. A solution containing lactulose, rhamnose, sucrose, and sucralose was administered to subjects who were on fasting; the urine excreted during 5 h was collected and measured. Samples were analyzed by gas chromatography-tandem mass spectrometry and results were expressed as percentage of sugar recoveries and lactulose/rhamnose (L/R) ratio.
Results: The analyses showed a clear effect of low urinary volumes (≤240 mL) particularly affecting rhamnose excretion in healthy subjects and sucrose and sucralose recovery in diseased children. Despite the low rhamnose recovery, as lactulose is not similarly affected, the diagnostic reliability of L/R ratio is well preserved at low diuresis conditions. However, this ratio can be useful to discriminate acute conditions vs. clinical remissions only at high urine volumes. Data also suggest potential diagnostic applicability of sucrose and sucralose in children at high urine volumes.
Conclusions: In conclusion, the multi-sugar test has a good predictivity in pediatric subjects but results must be carefully interpreted in the face of reduced diuresis.
The authors thank Dr. Luca Ronfani and the Biostatistics Unit of our institution for performing the statistical analyses.
Conflict of interest statement
Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
References
1. Tooley KL, Howarth GS, Butler RN. Mucositis and non-invasive markers of small intestinal function. Cancer Biol Ther 2009;8:753–8.10.4161/cbt.8.9.8232Suche in Google Scholar
2. Menzies IS, Laker MF, Pounder R, Bull J, Heyer S, Wheeler PG, et al. Abnormal intestinal permeability to sugars in villous atrophy. Lancet 1979;2:1107–9.10.1016/S0140-6736(79)92507-8Suche in Google Scholar
3. Mattioli F, Fucile C, Marini V, Isola L, Montanaro F, Savarino V, et al. Assessment of intestinal permeability using sugar probes: influence of urinary volume. Clin Lab 2011;57:909–18.Suche in Google Scholar
4. Medeiros PM, Simoneit BR. Analysis of sugars in environmental samples by gas chromatography-mass spectrometry. J Chromatogr A 2007; 1141:271–8.10.1016/j.chroma.2006.12.017Suche in Google Scholar
5. Hyams J, Markowitz J, Otley A, Rosh J, Mack D, Bousvaros A, et al. Evaluation of the pediatric crohn disease activity index: a prospective multicenter experience. J Pediatr Gastroenterol Nutr 2005;41:416–21.10.1097/01.mpg.0000183350.46795.42Suche in Google Scholar
6. Turner D, Hyams J, Markowitz J, Lerer T, Mack DR, Evans J, et al. Appraisal of the pediatric ulcerative colitis activity index (PUCAI). Inflamm Bowel Dis 2009;15:1218–23.10.1002/ibd.20867Suche in Google Scholar
7. Piena-Spoel M, Albers MJ, ten KJ, Tibboel D. Intestinal permeability in newborns with necrotizing enterocolitis and controls: does the sugar absorption test provide guidelines for the time to (re-)introduce enteral nutrition? J Pediatr Surg 2001;36:587–92.10.1053/jpsu.2001.22288Suche in Google Scholar
8. van Wijck K, Verlinden TJ, van Eijk HM, Dekker J, Burrman WA, Dejong CH, et al. Novel multi-sugar assay for site-specific gastrointestinal permeability analysis: a randomized controlled crossover trial. Clin Nutr 2013;32:245–51.10.1016/j.clnu.2012.06.014Suche in Google Scholar
9. Oriishi T, Sata M, Toyonaga A, Sasaki E, Tanikawa K. Evaluation of intestinal permeability in patients with inflammatory bowel disease using lactulose and measuring antibodies to lipid A. Gut 1995;36:891–6.10.1136/gut.36.6.891Suche in Google Scholar
10. Arrieta MC, Bistritz L, Meddings JB. Alterations in intestinal permeability. Gut 2006;55:1512–20.10.1136/gut.2005.085373Suche in Google Scholar
11. Meddings JB, Sutherland LR, Byles NI, Wallace JL. Sucrose: a novel permeability marker for gastroduodenal disease. Gastroenterology 1993;104:1619–26.10.1016/0016-5085(93)90637-RSuche in Google Scholar
12. McOmber ME, Ou CN, Shulman RJ. Effects of timing, sex, and age on site-specific gastrointestinal permeability testing in children and adults. J Pediatr Gastroenterol Nutr 2010;50: 269–75.10.1097/MPG.0b013e3181aa3aa9Suche in Google Scholar PubMed PubMed Central
©2014 by Walter de Gruyter Berlin Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- The ten commandments of laboratory testing for emergency physicians
- Review
- Critical role of RAGE in lung physiology and tumorigenesis: a potential target of therapeutic intervention?
- Opinion Papers
- Do we really need high-sensitive troponin immunoassays in the emergency department? Definitely, yes!
- Do we really need high-sensitivity troponin immunoassays in the emergency department? Maybe not
- General Clinical Chemistry and Laboratory Medicine
- Cortisol and cortisone ratio in urine: LC-MS/MS method validation and preliminary clinical application
- Urinary neutrophil gelatinase-associated lipocalin (NGAL) excretion increases in normal pregnancy but not in preeclampsia
- Influence of urine volume on the assessment of intestinal permeability in affected children by multiple sugar probes
- Measurement of amino terminal propeptide of type III procollagen (PIIINP) employing the ADVIA Centaur platform. Validation, reference interval and comparison to UniQ RIA
- Cancer Diagnostics
- Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
- Immunological screening for tumor cells in serous body fluids has added value with the CELL-DYN Sapphire
- Cardiovascular Diseases
- The value of clinical and laboratory diagnostics for chest pain patients at the emergency department
- The concentration of high-sensitivity troponin I, galectin-3 and NT-proBNP substantially increase after a 60-km ultramarathon
- Autoantibody prevalence with an improved immunoassay for detecting cardiac troponin-specific autoantibodies
- Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia
- Association of the GCKR rs780094 polymorphism with metabolic traits including carotid intima-media thickness in Japanese community-dwelling men, but not in women
- Infectious Diseases
- Analysis of antibody response (IgM, IgG, IgG3) to Chikungunya virus using panel of peptides derived from envelope protein for serodiagnosis
- Letters to the Editor
- A short story on how the H-index may change the fate of scientists and scientific publishing
- A new and effective way for preventing pre-analytical laboratory errors
- Digital immunofluorescence enables automated detection of antinuclear antibody endpoint titers avoiding serial dilution
- Multicenter method evaluation of the ARK™ Methotrexate Immunoassay
- Haemoglobinopathies in nonendemic areas in recent years
- Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: some results
- Effect of recalibration of the hs-TnT assay on diagnostic performance
Artikel in diesem Heft
- Frontmatter
- Editorial
- The ten commandments of laboratory testing for emergency physicians
- Review
- Critical role of RAGE in lung physiology and tumorigenesis: a potential target of therapeutic intervention?
- Opinion Papers
- Do we really need high-sensitive troponin immunoassays in the emergency department? Definitely, yes!
- Do we really need high-sensitivity troponin immunoassays in the emergency department? Maybe not
- General Clinical Chemistry and Laboratory Medicine
- Cortisol and cortisone ratio in urine: LC-MS/MS method validation and preliminary clinical application
- Urinary neutrophil gelatinase-associated lipocalin (NGAL) excretion increases in normal pregnancy but not in preeclampsia
- Influence of urine volume on the assessment of intestinal permeability in affected children by multiple sugar probes
- Measurement of amino terminal propeptide of type III procollagen (PIIINP) employing the ADVIA Centaur platform. Validation, reference interval and comparison to UniQ RIA
- Cancer Diagnostics
- Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
- Immunological screening for tumor cells in serous body fluids has added value with the CELL-DYN Sapphire
- Cardiovascular Diseases
- The value of clinical and laboratory diagnostics for chest pain patients at the emergency department
- The concentration of high-sensitivity troponin I, galectin-3 and NT-proBNP substantially increase after a 60-km ultramarathon
- Autoantibody prevalence with an improved immunoassay for detecting cardiac troponin-specific autoantibodies
- Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia
- Association of the GCKR rs780094 polymorphism with metabolic traits including carotid intima-media thickness in Japanese community-dwelling men, but not in women
- Infectious Diseases
- Analysis of antibody response (IgM, IgG, IgG3) to Chikungunya virus using panel of peptides derived from envelope protein for serodiagnosis
- Letters to the Editor
- A short story on how the H-index may change the fate of scientists and scientific publishing
- A new and effective way for preventing pre-analytical laboratory errors
- Digital immunofluorescence enables automated detection of antinuclear antibody endpoint titers avoiding serial dilution
- Multicenter method evaluation of the ARK™ Methotrexate Immunoassay
- Haemoglobinopathies in nonendemic areas in recent years
- Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: some results
- Effect of recalibration of the hs-TnT assay on diagnostic performance