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Intestinal permeability is decreased in anorexia nervosa

Abstract

Malnutrition and absence of exogenous luminal nutrients in the gastrointestinal tract affect intestinal permeability (IP) leading to an increased penetration of substances that passively cross intestinal epithelium via intercellular pathways. We hypothesised that an increase in IP could occur in patients with anorexia nervosa because of their prolonged fasting and chronic malnutrition. Therefore, we assessed IP in 14 drug-free anorexic women and 19 drug-free age-matched healthy women by means of the lactulose/mannitol (LA/MA) test. To this purpose, after an overnight fast, subjects ingested an oral solution containing 5 g lactulose and 2 g mannitol in 100 ml water. Urine specimens were collected immediately before and 30, 60, 120, 180, 240 and 300 min after the ingestion of the sugar solution. Urinary lactulose and mannitol were determined by high-performance anion exchange chromatography coupled with pulsed amperometric detection. We found that IP, as expressed by the 5-h LA/MA excretion ratio, was significantly decreased in anorexic women because of a lower urinary recovery of lactulose. Moreover, in patients, the time course of lactulose excretion significantly differs from healthy controls. These results do not confirm our hypothesis of increased IP in anorexia nervosa. Since IP reflects the anatomo-functional status of intestinal mucosa, the present findings support the idea that changes in the anatomo-physiology of intestinal mucosa occur in anorexia nervosa.

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References

  1. Groos S, Hunfeld, Luciano L . Parenteral versus enteral nutrition: morphological changes in human adult intestinal mucosa. J Sub-Microsc Cytol Pathol 1996; 28: 61–74.

    CAS  Google Scholar 

  2. Miura S, Tanaka S, Yoshioka M, Serizawa H, Tashiro H, Shiozaki H et al. Changes in intestinal absorption of nutrients and brush border glycoproteins after total parenteral nutrition in rats. Gut 1992; 33: 484–489.

    Article  CAS  Google Scholar 

  3. Carey HV, Cooke HJ . Effect of hibernation and jejunal bypass on mucosal structure and function. Am J Physiol Gastrointest Liver Physiol 1991; 261: G37–G44.

    Article  CAS  Google Scholar 

  4. Carey HV, Hayden UL, Tuker KE . Fasting alters basal and stimulated ion transport in piglet jejunum. Am J Physiol Regulatory Integrative Comp Physiol 1994; 267: R156–R163.

    Article  CAS  Google Scholar 

  5. Ferraris RP, Carey HV . Intestinal transport during fasting and malnutrition. Ann Rev Nutr 2000; 20: 195–219.

    Article  CAS  Google Scholar 

  6. Elia M, Behrens R, Northrop C, Wraight P, Neale G . Evaluation of mannitol, lactulose and 51Cr-labelled ethylenediaminetetra-acetate as markers of intestinal permeability in man. Clin Sci 1987; 73: 197–204.

    Article  CAS  Google Scholar 

  7. Welsh FKS, Farmery SM, MacLennan K, Sheridan MB, Barclay GR, Guillou PJ et al. Gut barrier function in malnourished patients. Gut 1998; 42: 396–401.

    Article  CAS  Google Scholar 

  8. Maxton DG, Menzies IS, Slavin B, Thompson RP . Small intestinal function during enteral feeding and starvation in man. Clin Sci 1989; 77: 401–406.

    Article  CAS  Google Scholar 

  9. Elia M, Goren A, Behrens R, Neale G . Effect of total starvation and very low calorie diets on intestinal permeability in man. Clin Sci 1987; 73: 205–210.

    Article  CAS  Google Scholar 

  10. Windsor JA, Hill GL . Protein depletion and surgical risk. Aust N Z J Surg 1988; 58: 711–715.

    Article  CAS  Google Scholar 

  11. Meguild MM, Debonis D, Meguld V . Complications of abdominal operations for malignant disease. Am J Surg 1988; 156: 341–345.

    Article  Google Scholar 

  12. Deitch EA . Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 1992; 216: 117–134.

    Article  CAS  Google Scholar 

  13. First MB, Spitzer RL, Gibbon M, Williams JB . Stuctured clinical interview for DSM-IV axis I disorders (SCID-I). Research Version Biometrics, Research Department, New York State Psychiatric Institute, New York, 1995

  14. Andreasen NC, Endicott J, Spitzer RL, Winokur G . The family history method using diagnostic criteria: reliability and validity. Arch Gen Psychiatry 1997; 34: 1229–1235.

    Article  Google Scholar 

  15. Generoso M, De Rosa M, De Rosa R, De Magistris L, Secondulfo M, Fiandra R et al. Cellobiose and lactulose coupled with mannitol and determined using ion-exchange chromatography with pulsed amperometric detection, are reliable probes for investigation of intestinal permeability. J Chromatogr B 2003; 783: 349–357.

    Article  CAS  Google Scholar 

  16. Bjarnason, MacPherson A, Hollander D . Intestinal permeability: an overview. Gastroenterol 1995; 108: 1566–1581.

    Article  CAS  Google Scholar 

  17. Dixon J . BMDP Statistical Software. University of California Press: Berkeley, 1985.

    Google Scholar 

  18. Blomquist L, Bark T, Edenborg G, Norman A . Evaluation of the lactulose/mannitol and 51Cr-ethylendiaminetetraacetic acid/14C-mannitol methods for intestinal permeability. Scan J Gastroenterol 1997; 32: 805–812.

    Article  CAS  Google Scholar 

  19. Pomeroy C, Mitchell JE . Medical complications of anorexia nervosa and bulimia nervosa. In: Fairburn CG, Brownell KD (eds), Eating Disorders and Obesity. 2nd edn. Guilford Press: New York, 2002, pp 278–285.

    Google Scholar 

  20. Peterson CA, Ney DM, Hinton PS, Carey HV . Beneficial effects of insuline-like growth factor I on epithelial structure and function in parenterally fed rat jejunum. Gastrenterol 1996; 111: 1501–1508.

    Article  CAS  Google Scholar 

  21. Stoving RK, Hangaard J, Hagen C . Update on endocrine disturbances in anorexia nervosa. J Pediatr Endocrinol Metab 2001; 14: 459–480.

    Article  CAS  Google Scholar 

  22. Garcia-Arnes J, Sierra C, Tinahones F, Monzon A, Lopez MJ, Mazuecos N et al. Intestinal permeability in adult patients with growth hormone deficiency. J Endocrinol Invest 2001; 24: 78–82.

    Article  CAS  Google Scholar 

  23. Wang W, Uzzau S, Goldblum SE, Fasano A . Human zonulin, a potential modulator of intestinal tight junctions. J Cell Sci 2000; 113: 4435–4440.

    CAS  PubMed  Google Scholar 

  24. Bowers TK, Eckert E . Leukopenia in anorexia nervosa: lack of risk of increased infection. Arch Intern Med 1978; 138: 1520–1523.

    Article  CAS  Google Scholar 

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Correspondence to P Monteleone.

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Monteleone, P., Carratù, R., Cartenì, M. et al. Intestinal permeability is decreased in anorexia nervosa. Mol Psychiatry 9, 76–80 (2004). https://doi.org/10.1038/sj.mp.4001374

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