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Title: Measurement of intestinal permeability in surgical patients
Author: Anderson, Alexander Douglas Gray
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2004
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Aim: The aim of this study was to investigate the use of a triple sugar test of intestinal permeability as a surrogate marker of gut barrier function in surgical patients. Methods: Original laboratory work included the development of a technique for the quantification of urinary sucralose using high performance liquid chromatography (HPLC) with refractive index detection. Other techniques used included HPLC analysis of urinary lactulose and rhamnose, quantification of urinary 51Cr-EDTA by gamma counting, and a lactulose-hydrogen breath test. The triple sugar test involved ingestion of a test drink containing sucralose (5g), lactulose (5g) and rhamnose (1g). Urine was collected for 24 hours in 2 aliquots (first 5 and last 19 hours) and sugar concentrations determined by HPLC. A 51Cr-EDTA test was administered separately as an independent measure of “whole-gut” permeability. Healthy volunteers (n=21) and ileostomists (n=18) were studied in order to investigate the sites of absorption of sugar probes. A number of patient groups were then studied; these included subjects with Crohn’s disease (n=16),acute colitis (n=18), IBS (n=11), acute pancreatitis (n=9) and patients undergoing chemotherapy (n=7). Results: Assays for urinary sugars were both accurate and precise (coefficient of variation approximately 5%). Studies in ileostomists and controls indicated that 24-hr sucralose excretion represented “whole-gut” permeability, whereas the 5-hr lactulose/rhamnose excretion ratio represented small intestinal permeability. Small intestinal permeability was increased in subjects with Crohn’s disease (p=0.007) and acute pancreatitis (p=0.004), versus controls. “Whole gut” permeability was significantly increased in patients with Crohn’s (p=0.001) and pancreatitis (p<0.001), and significantly reduced in patients undergoing chemotherapy (p=0.012). The proportion of sucralose excreted in the last 19 hours of collection was significantly increased in patients with Crohn’s (p=0.026), acute colitis (0.023) and acute pancreatitis (p=0.049), implying an increase in colonic permeability.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available