INTESTINAL LACTULOSE PERMEABILITY REFLECTS EXOCRINE PANCREATIC DYSFUNCTION

Abstract

Our previous work suggested that increased intestinal permeability was related to the degree of exocrine pancreatic dysfunction in Cystic Fibrosis (CF). Others have suggested this finding represents a specific abnormality of CF. To further evaluate this question we studied CF (n=31) and non-CF (n=10) patients (Shwachman Syndrome) with variable degrees of exocrine pancreatic dysfunction They were categorized into pancreatic insufficient (PI) and pancreatic sufficient (PS) groups based on fecal fat balance studies. After an overnight fast, patients were fed 20 grams of lactulose and urine was collected for 8 hours. Urinary lactulose excretion (% intake) was determined by thin-layer chromatography. Mean urinary lactulose excretion was no different between CF and non-CF patients with either PI (2.10±1.21 and 1.92±0.76) or PS (0.63±0.49 and 0.61±0.34). There was a significant difference in lactulose excretion between PI and PS patients in CF and non-CF groups (p<0.0001 and p<0.013, respectively). This relationship was explained by comparing pancreatic function (trypsin output, units/kg/ hour) with urinary lactulose excretion in 26 patients. A non-linear inverse relationship was observed between the two parameters. A plot of the log(x) transformation of duodenal trypsin output against urinary lactulose excretion revealed a highly significant linear relationship (r=0.778, p=0.0001). These data confirm a direct relationship between intestinal lactulose permeability and the degree of exocrine pancreatic dysfunction, unrelated to etiology.

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