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Abnormal Small Intestinal Permeability in Patients with Idiopathic Malabsorption in Tropics (Tropical Sprue) Does Not Change Even After Successful Treatment

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Abstract

Background

Though tropical sprue (TS) is common in tropics, studies on small intestinal permeability (SIP) in TS are scant.

Method

SIP was evaluated using 1H nuclear magnetic resonance (NMR) spectroscopy of urinary lactulose and mannitol in 24 patients with TS (22 before and 15 after treatment with tetracycline and folate) and in 31 healthy subjects (HS). Effect of treatment of TS on SIP and its relationship with outcome were studied.

Result

Subjects were comparable in terms of age and gender. Before treatment, urinary lactulose (0.24 mmol, 0–1.09 mmol versus 0.09 mmol, 0–0.68 mmol, P = 0.02) and lactulose-to-mannitol (L/M) ratio (0.11, 0–0.41 versus 0.042, 0–0.26, P = 0.001) were higher in TS than in HS, though mannitol was comparable (2.7 mmol, 0.61–10.5 mmol versus 3.8 mmol, 1.3–16.4 mmol, P = 0.08). Patients improved after treatment [stool frequency (9, 4–20/day versus 1, 1–2/day, P < 0.0001), weight (44.4, 32–69 kg, versus 56, 39–84 kg, P < 0.0001), fecal fat (10.1, 6–26 g/24 h versus 4.4, 3.0–6.7 g/24 h, P < 0.0001), d-xylose (0.57, 0.28–1.2 g/5 g/5 h versus 1.1, 0.2–2.1 g/5 g/5 h, P < 0.0001), and small intestinal bacterial overgrowth (SIBO) resolved in 10/24 (41.7%) versus 1/15 (6.6%), P = 0.02]. Though urinary lactulose (0.17, 0–4.3 mmol versus 0.09, 0–0.68 mmol, P = 0.11) and mannitol (2.17, 0.8–36.7 mmol versus 3.84, 1.3–16.4 mmol, P = 0.06) were comparable, L/M ratio was higher in TS than in HS (0.09, 0–0.22 versus 0.042, 0–0.26, P = 0.002). L/M ratio was more often abnormal (cutoff 0.078) in TS than in HS [14/22 (63.6%) versus 3/31 (9.7%); P = 0.0001], which persisted even after treatment [9/15 (60%) as compared with HS; P = 0.0006]. Persistently abnormal SIP was associated with less weight gain and frequent stools following treatment.

Conclusion

SIP is often abnormal in TS and remains unchanged even after successful treatment that was associated with less weight gain and more frequent stool.

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Acknowledgments

Authors thank Mr. Raghunath of the Gastrointestinal Pathophysiology and Motility Lab of SGPGI, Lucknow for technical help. Authors must thanks all patients and volunteers for taking part in this study. This work was supported by extramural research grants from the Department of Science and Technology (nos. SR/SO/HS-23/2003 and SR/SO/HS-15/2007), Government of India to U.C.G. Sunil Kumar thanks the Indian Council of Medical Research (ICMR), New Delhi for providing his fellowship. C.L.K. thanks the Department of Science and Technology for financial support to the Center for Biomedical Magnetic Resonance, SGPGI, Lucknow, India. K.J. thanks the Council of Scientific and Industrial Research for her fellowship.

Conflict of interest statement

There are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Sunil Kumar, Uday C. Ghoshal & Asha Misra

  2. Centre of Biomedical Magnetic Resonance, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Kamaiah Jayalakshmi, Raja Roy & C. L. Khetrapal

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  1. Sunil Kumar
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  2. Uday C. Ghoshal
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  3. Kamaiah Jayalakshmi
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Correspondence to Uday C. Ghoshal.

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Kumar, S., Ghoshal, U.C., Jayalakshmi, K. et al. Abnormal Small Intestinal Permeability in Patients with Idiopathic Malabsorption in Tropics (Tropical Sprue) Does Not Change Even After Successful Treatment. Dig Dis Sci 56, 161–169 (2011). https://doi.org/10.1007/s10620-010-1232-3

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