Shulman RJ^1,2,3, Devaraj S^3,4, Heitkemper M⁵. Neurogastroenterol Motil. 2020 Mar;32(3):e13765. doi: 10.1111/nmo.13765. Epub 2019 Dec 9.

Author information

1 Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

2 Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas.

3 Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.

4 Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.

5 University of Washington, Seattle, Washington.

Abstract

BACKGROUND: Gut permeability is increased in some children and adults with irritable bowel syndrome (IBS). We investigated whether this also is true for children with functional abdominal pain (FAP). We also determined whether sex affected permeability results.

METHODS: Sucrose, lactulose, mannitol, and sucralose were ingested after an overnight fast in well-phenotyped children with IBS (n = 95), FAP (n = 25), and healthy controls (HC) (n = 60). Urine was collected for 24 hours. Percent sucrose recovery was calculated based on the 0- to 3-hour collection; lactulose/mannitol ratio both on the 0- to 3-hour and 0- to 24-hour collections; and percent sucralose recovery on the 0- to 24-hours collection.

KEY RESULTS: Age was similar among the groups (P = .26). The lactulose/mannitol ratio was increased in IBS compared with HC at 0-3 and 0-24 hours (P = .023, P = .05, respectively). Percent sucralose recovery was greater in FAP than in HC (P = .045). No differences were noted among the groups in percent sucrose recovery. Taking sex into account, percent sucrose recovery was greater in girls with IBS vs HC girls (P = .008). The lactulose/mannitol ratio was greater in boys with IBS compared with HC boys at both time points (both P = .02). Percent sucralose recovery was greater in boys with IBS than in FAP or HC (both P < .001).

CONCLUSIONS AND INFERENCES: Sex is a critically important factor when measuring gut permeability. Boys with IBS have increased lactulose/mannitol ratios and percent sucralose recovery. Girls with IBS have increased percent recovery of sucrose. Children with FAP do not demonstrate abnormal gut 0permeability even taking sex into account.