Cellobiose/mannitol sugar test--a sensitive tubeless test for coeliac disease: results on 1010 unselected patients.

Abstract

SUMMARY The cellobiose/mannitol (Ce/Ma) test is a non-invasive technique for investigating intestinal permeability. In coeliac disease there is a decreased absorption of small molecules and paradoxically increased absorption of large molecules. The simultaneous administration of cellobiose and mannitol as two probe molecules allows the permeability of the small bowel mucosa to be studied, eliminating extraneous factors such as gastric emptying, and incomplete urine collection. One thousand and ten patients presenting to a gastroenterology clinic with symptoms, signs, or biochemical indices compatible with coeliac disease had a Ce/Ma test. Eight hundred and seventeen had a normal test and of these 197 had a jejunal biopsy showing 148 normal mucosa, two coeliac disease, 43 non-specific abnormalities, four giardiasis. One hundred and ninety three had an abnormal test; of these 132 had a jejunal biopsy showing 62 normal mucosa, 48 coeliac disease, and 22 other abnormalities. Considering those who had jejunal biopsies, the sensitivity of the test for coeliac disease is 96%, specificity 70%, the predictive value of the positive 36%, and predictive value of the negative 99%. Eleven per cent of the patients with a 'false positive' test had abnormalities in the jejunal biopsy or a diagnosis which could explain the abnormal permeability.The Ce/Ma test is a non-invasive investigation of small bowel permeability. l 2 Cellobiose, a disaccharide (molecular radius 0.50 nm) and mannitol, a polyhydric alcohol (molecular radius 0-40 nm) are taken orally in hypertonic solution and a five hour urine collection is analysed for both probe molecules, the results being expressed as a ratio of the percentage recoveries.' In coeliac disease more cellobiose and less mannitol is absorbed than in normal subjects.' By expressing the results as a ratio there is good separation of coeliacs from normal subjects and the influence of certain non-intestinal factors acting similarly on both molecules such as renal impairment, gastric and bladder emptying and are eliminated.4Although results of the Ce/Ma test have been reported previously they relate to small numbers of

Increased intestinal permeability in malnourished patients with liver cirrhosis

“…12,18 Reduced mannitol excretion indicates villous atrophy. [19][20][21][22][23] In alcoholic liver disease, villous atrophy is frequently observed; reduction in villous height in relation to crypt depth and lower mucosal surface have been detected by light microscopy in alcoholics, even in the absence of cirrhosis. [24][25][26] Following the introduction of capsule endoscopy, mucosal abnormalities of the small intestine in liver cirrhosis patients with portal hypertension have been well documented and include inflammatory-like abnormalities (oedema, erythema, granularity and friability) as well as vascular lesions (cherry red spots, telangiectasias or angiodysplasia-like lesions and varices).…”

Differential in vivo and in vitro intestinal permeability to lactulose and mannitol in animals and humans: A hypothesis

“…These recovery changes are most prominent when there is a marked villus atrophy. [23][24][25] Because the species in our study show substantial differences in villus height, the question arises whether the villus height correlates with L/M ratios. We averaged relevant literature data 26-52 on villus height in Table 3.…”

Introduction: A welcome to the first special animal health issue of AAPS PharmSci

“…Interspecies differences associated with the biliary recycling of compounds may reflect some of the differences that might occur in patients whose gall bladders have been removed. 20 Variability in gastrointestinal (GI) transit time may reflect differences that could occur in those diseases that induce GI motility changes in humans, such as Crohn's disease, 21 villus atrophy, 22 HIV infection, 23 stress, 24 and pain. 25 Therefore, improving the ability to predict species-by-formulation interactions in animal species may significantly improve our understanding of the adaptations needed to accommodate the changes in human drug absorption that may occur during medically relevant situations.…”