Original Contribution

The American Journal of Gastroenterology (2006) 101, 1288–1294; doi:10.1111/j.1572-0241.2006.00672.x

Abnormal Intestinal Permeability in Subgroups of Diarrhea-Predominant Irritable Bowel Syndromes

Simon P Dunlop MD, John Hebden MD, Eugene Campbell MB, Jorgen Naesdal MD, Lars Olbe MD, Alan C Perkins PhD and Robin C Spiller MD

Wolfson Digestive Diseases Centre and Division of Medical Physics, University Hospital, Nottingham, United Kingdom

Correspondence: Robin Spiller, MD, Division of Gastroenterology, University Hospital, Nottingham, NG7 2UH.

Received 13 July 2004; Accepted 20 December 2005.

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Abstract

OBJECTIVES:

 

Irritable bowel syndrome (IBS) is a heterogeneous condition and defined according to symptoms. Low-grade inflammation has been associated with IBS, particularly that following infection, but whether altered intestinal permeability profiles relate to irritable bowel subtype or onset is uncertain. Our aim was to compare small and large intestinal permeability in various subtypes of IBS to healthy controls.

METHODS:

 

Intestinal permeability was measured using 1.8 MBq of 51Cr-EDTA and collecting urine over 24 h; Study 1: patients with diarrhea-predominant postinfectious IBS (N = 15), constipation-predominant IBS (N = 15), and healthy controls (N = 15); Study 2: two groups of diarrhea-predominant IBS (D-IBS), one with a history of onset after acute gastroenteritis (postinfectious) (N = 15) and the other without such a history (nonpostinfectious) (N = 15) both compared with healthy controls (N = 12).

RESULTS:

 

Permeability expressed as percentage of total dose excreted in urine (median [inter-quartile range]). Study 1: Proximal small intestinal permeability was increased in postinfectious IBS (0.19 [0.12–0.23]) in contrast to constipated IBS (0.085 [0.043–0.13]) and controls (0.07 [0.035–0.19]) (p = 0.02). IBS patients with eczema, asthma, or hayfever had increased proximal small intestinal permeability compared with IBS patients without atopy (p = 0.02). Study 2: Small intestinal permeability was greater in nonpostinfectious diarrhea-predominant IBS (0.84 [0.69–1.49]) compared with postinfectious IBS (0.43 [0.29–0.63], p = 0.028) or controls (0.27 [0.2–0.39]), p = 0.001).

CONCLUSIONS:

 

Small intestinal permeability is frequently abnormal in diarrhea-predominant IBS. Those without a history of infectious onset appear to have a more severe defect.