INTESTINAL PERMEABILITY IN CROHNS-DISEASE AND ITS RELATION TO DISEASE-ACTIVITY AND RELAPSE FOLLOWING TREATMENT WITH AN ELEMENTAL DIET

Objective: To assess the relationship between clinical disease activity, intestinal permeability and intestinal inflammation in patients with small intestinal Crohn's disease. Methods: Twenty-nine patients with small intestinal Crohn's disease were assessed clinically and underwent permeability studies with iso-, hyper- and hypo-osmolar test solutions and indium-111 leucocyte studies, which involved faecal collections over 4 days, to quantify intestinal inflammation. Thirteen patients were re-studied following treatment with an elemental diet and followed-up to assess whether any of the parameters could predict early relapse following this treatment. Results: There was a noticeable lack of correlation between clinical disease activity, increased intestinal permeability and intestinal inflammation. Although all the patients improved significantly during treatment with an elemental diet, there was no significant correlation between the degree of improvement assessed by the three techniques. However, increased intestinal permeability at the end of treatment predicted early relapse. Conclusions: Most patients with active small intestinal Crohn's disease have increased intestinal permeability and increased faecal excretion of indium-111 neutrophils. Neither correlated significantly with clinical disease activity. All appear suitable to assess response to treatment. Increased intestinal permeability following treatment with an elemental diet may identify patients who are prone to early relapse.