Original article
Correlation of intestinal lactulose permeability with exocrine pancreatic dysfunction

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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<0.001 and p<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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Supported by grants from the Cystic Fibrosis Foundation (United States), the National Institutes of Health (grant No. R01 AM 35091), the Medical Research Council of Canada, and the Canadian Cystic Fibrosis Foundation. A portion of this work was performed in the Pediatric Clinical Research Center, Johns Hopkins Hospital (grant No. RR-00052). Dr. Mack held a Duncan Gordon Research Fellowship, Hospital for Sick Children. Dr. Flick held a Clinician Scientist Award, Johns Hopkins University School of Medicine.