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Francavilla, R.1; Magistà, A.1; Bucci, N.1; De Canio, A.1; Gagliardi, F.1; Polimeno, L.2; Castellaneta, S. P.3; Lionetti, E.1; Boscarelli, G.1; Straziouso, S.1; Miniello, V. L.4
1CIRGEEE Biomedicina dell’Età Evolutiva, 2Gastroenterologia, Università degli Studi di Bari, 3Pediatria, Ospedale San Paolo, 4Biomedicina Età Evolutiva, Università degli Studi di Bari, Bari, Italy
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Introduction: Recently, a role of low grade mucosal inflammation has been hypothesised to play a role in irritable bowel syndrome (IBS) on the evidence that a) patients with IBS have an increased number of inflammatory cells in intestinal mucosa and b) previous episodes of infectious enteritis, food allergies, and modification in the gut microflora may promote IBS (1). The aim of our study was to assess intestinal permeability in children with IBS and compare it to that of children with celiac disease (CD), inflammatory bowel disease (IBD) and healthy controls (C).
Methods: Between June 2002 and August 2003 all the 134 consecutive children seen in our GI out-patient clinic for recurrent abdominal pain were carefully evaluated for the presence of IBS according to the Roma criteria (2). After having excluded all the possible organic causes of disease, 19 [M:8; median age: 9.1 y (4.2–12.3)] were diagnosed as having IBS. During the same period, 16 consecutive newly diagnosed children with either CD [n:10, (M:6), median age: 5.6 y (2.3–9.1)] or IBD [n:6, (M:2), median age: 10.5 y (5.6–16)], and 23 C [M:10; median age: 6.1 y (2.1–13.5)], were also enrolled. All underwent double sugar (lactulose and mannitol) intestinal permeability test according to Generoso et al. (3) using pulsed amperometric detection (DIONEX DX 600) and result were expressed as ratio between the two sugars (La/Ma).
Results: Children in the four groups were homogeneous for demographic variables. La/Ma ratios in the different groups of children were: IBS 0.029 (0.01–0.3), CD 0.071 (0.046–0.087), IBD 0.14 (0.11–0.26), C 0.018 (0.001–0.04). As expected, intestinal permeability in children with IBD and CD was significantly higher than in C (p<0.0001; p<0.0001); interestingly, children with IBS have a significantly higher La/Ma ratio than C (p<0.001).
Conclusion: The presence of an altered intestinal permeability in children with IBS supports the hypotesis of a low grade mucosal inflammation in the pathogenesis of this condition and might provide a mechanism for its maintenance by exposing the gut to luminal antigen thusactivating the mucosal immune system.
© 2004 Lippincott Williams & Wilkins, Inc.
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