Intestinal permeability compared in pediatric and adult patients with inflammatory bowel disease.

Increased urinary excretion of 51Cr-EDTA after oral administration has been demonstrated in adults with active inflammatory bowel disease (IBD). Pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC) were compared to pediatric and adult controls and adult patients with IBD using this technique. Seventy-five pediatric IBD patients, 51 (mean age 13.8 y) diagnosed with active CD and 24 (mean age 11.9 y) with active UC, were examined. These were compared to 26 pediatric controls with recurrent abdominal pain or chronic non-specific diarrhea. Further comparison was made to 80 adult controls (mean 32.0 y), 63 adults with active CD and 31 adults with active UC. After an overnight fast, 925 kBq of 51Cr-EDTA was given orally and urine collected for 24 h. Excretion of the probe by the pediatric controls and adult controls was 1.5%/24 h and 1.3%/24 h (median), respectively. Of the pediatric patients, 45/51 (88.2%) with active CD (median 3.9%/24 h) and 16/24 (66.7%) with active UC (median 4.8%/24 h) showed increased excretion. Pediatric patients with active IBD demonstrated increased probe excretion comparable to levels of adult patients. In the pediatric population, accuracy of the first test was 83.0%. Thus, urinary excretion of 51Cr-EDTA is a useful non-invasive test in the investigation of pediatric patients with gastrointestinal symptoms.

A short review of the relationship between intestinal permeability and inflammatory joint disease.

The potential aetiological relationship between increased intestinal permeability and inflammatory joint disease is reviewed. The known physiology of intestinal permeability is outlined and the alterations which occur in different disease states are described. A rationale is given for the hypothesis that the gut is the likely source of the antigens causing inflammatory arthritis, and the studies of this hypothesis to date are reviewed.

Small bowel and colonic permeability to 51Cr-EDTA in patients with active inflammatory bowel disease.

51Cr-EDTA was administered both orally and per rectum via a catheter to controls and to patients with inflammatory bowel disease. The patients were divided into two groups, either with active inflammation of the small bowel or with active inflammation of the colon. Fifteen patients with Crohn's disease of the small bowel and 19 patients with either Crohn's disease of the colon or ulcerative colitis were investigated. After oral administration of the probe, controls showed a median excretion of 1.17%/24 h of the dose compared to 3.47%/24 h by patients with small bowel disease and 6.07%/24 h by patients with colonic disease. After rectal administration, controls showed a median excretion of 0.74%/24 h of the dose compared to 0.93%/24 h by patients with small bowel disease and 5.73%/24 h by patients with colonic disease. The rectal test differentiated small bowel disease from colonic disease with an accuracy of 85%. The results confirmed the inflamed colon as a site of increased intestinal permeation.

The isolation and identification of indigoid pigments from urine.

A purple pigment, phyriaviolin, and a blue pigment, phyriaazulin, have been found in relatively large amounts in the urine of patients suffering from two diverse pathological conditions, porphyria cutanea tarda and Crohn's disease. The two pigments have been characterised by chemical, spectroscopic, and chromatographic studies and identified to be indirubin and indigo (indigotin). Possible reasons for their formation are discussed.

Reversibility of increased intestinal permeability to 51Cr-EDTA in patients with gastrointestinal inflammatory diseases.

Intestinal permeability in adults with inflammatory gastrointestinal diseases was investigated by measuring the 24-h urinary excretion of orally administered 51Cr-EDTA. Eighty controls along with 100 patients with Crohn's disease, 46 patients with ulcerative colitis, 20 patients with gluten-sensitive enteropathy, and 18 patients with other diseases were studied. In controls, the median 24-h excretion was 1.34%/24 h of the oral dose. Patients with Crohn's disease (median 2.96%/24 h), ulcerative colitis (median 2.12%/24 h), and untreated gluten-sensitive enteropathy (median 3.56%/24 h) had significantly elevated urinary excretion of the probe compared to controls (p less than 0.0001). Increased 24-h urinary excretion of 51Cr-EDTA had a high association with intestinal inflammation (p less than 0.0001). Test specificity and sensitivity were 96% and 57%, respectively. A positive test has a 96% probability of correctly diagnosing the presence of intestinal inflammation, whereas a negative test has a 50% probability of predicting the absence of disease.

Increased intestinal permeability in patients with rheumatoid arthritis: a side-effect of oral nonsteroidal anti-inflammatory drug therapy?

Intestinal permeability in controls and in patients with active rheumatoid arthritis was assessed by measuring the radioactivity in 24-h urine collections after oral administration of 51Cr-EDTA. Intestinal permeability in the patients was found to be significantly increased in comparison to controls. Of the patients, 6/7 (86%) not taking any prescribed nonsteroidal anti-inflammatory drug (NSAID) at the time of study had normal results, whereas 23/29 patients (79%) taking prescribed NSAIDs displayed increased intestinal permeability. It has not been determined beyond doubt whether this finding is due to disease process or therapy with oral NSAIDs.

Studies of intestinal permeability in inflammatory diseases using polyethylene glycol 400.

It has been proposed that increased bowel permeability might play a role in the pathogenesis of inflammatory disease. Intestinal permeation was investigated by measuring the 6-hour urinary excretion of polyethylene glycol (PEG) 400 in 40 adult volunteer controls and in patients with inflammatory disease. Of the patients, 15 had Crohn's disease; 7, ulcerative colitis; 2, celiac disease; and 7, rheumatoid arthritis. No significant difference in total urinary excretion over a 6-hour period was found between controls and patients with ulcerative colitis. Patients with Crohn's disease, celiac disease, or with rheumatoid arthritis were found to have significantly decreased urinary excretion of PEG 400. The results of this study indicate that there is no identifiable increase in intestinal permeation as measured by PEG 400 excretion during periods of active inflammatory disease.

111Indium-labelled polymorphonuclear leucocyte scans in rheumatoid arthritis--an important clinical cause of false positive results.

The presence of rheumatoid arthritis in patients undergoing 111indium-labelled polymorphonuclear leucocyte scanning represents a source of possible diagnostic confusion. In such patients, the labelled cells frequently accumulate over the caecum and ascending colon, despite the absence of obvious pathology of the large bowel. The aetiology of this effect is unknown.