Intestinal permeability luclozomanitol test

Intestinal Permeability Tests
Intestinal permeability tests are suitable in the diagnosis of diseases small intestine, malabsorptive syndrome, especially celiac disease. A whole range of markers can be used to assess intestinal permeability (monosaccharides, disaccharides, 51Cr-EDTA, polyethyleneglycol – PEG) or their combination. The lactulose/mannitol test (LA/MA test) is the most widely used in our country, combinations with cellobiose or sucrose are described. Lactulose is a marker of paracellular absorption, and in celiac disease, for example, there is a loosening of cellular bonds, an expansion of the tight zone and an increase in the permeability of lactulose. Mannitol is a marker of active transport through the cell (enterocyte) and in celiac disease the absorption of mannitol is reduced by the reduction of the active surface in atrophy of the intestinal mucosa. The LA/MA intestinal permeability test can be used to monitor postoperative chemotherapy.

Lactulose/mannitol test
It can also be combined with the administration of D-xylose, this version of the test was developed at the ÚKBD in Hradec Králové. A solution of 10 g of lactulose, 2 g of mannitol, 2 g of D-xylose and 11 g of glucose in 100 ml of distilled water is administered orally, the hyperosmolarity of the solution of 1500 mosm/l increases the sensitivity of the test. The patient must fast (12 hours, usually overnight) and collect urine for 5 hours after drinking the test solution. The analysis of individual sugars is carried out by the technique of gas chromatography, the relative amount of individual sugars in proportion to the administered amount and the final permeability indices LA/MA and LA/XY are calculated. The average value of the LA/MA index in the control group is 0.016 ± 0.008, the LA/XY index is 0.013 ± 0.009. Some other studies recommend wider combinations of the three substrates, e.g. with the administration of sucralose, which is stable during large intestine passage, other studies recommend a combined permeability and lactase test - LDI/SAT index.

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