Assessing the site of increased intestinal permeability in coeliac and inflammatory bowel disease

Background-The precise site of intestinal permeability changes in patients with coeliac and inflammatory bowel disease is unknown. Aims-To design a non-invasive technique for the localisation of altered gastrointestinal permeability to (51)chromium labelled EDTA ((51)CrEDTA). The method depends on comparing and defining concentration/time profiles in serum of a series of simultaneously ingested indicators with a well defined absorption site (3-0-methyl-D-glucose (jejunal indicator), (57)cobalt labelled vitamin B-12 (heal indicator), and sulphasalazine (caecal-colonic indicator)) in relation to simultaneously ingested (51)CrEDTA. Subjects-Five normal controls, six patients with untreated coeliac disease, five with Crohn's ileitis, and five with pan-ulcerative colitis underwent study, which entailed the simultaneous ingestion of the above four test substances followed, during the next 24 hours, by timed serial collection of urine and serum for marker analysis. Results-Urinary excretion of (51)CrEDTA was significantly increased in all patient groups. Analysis of serum appearances and profiles of the markers suggested that the increased intestinal permeation of (51)CrEDTA took place in the diseased jejunum in patients with coeliac disease, predominantly in the ileum in Crohn's disease and in the colon in the patients with pan-ulcerative colitis. Conclusion-A new non-invasive technique has been assessed that permits the localisation of the site of permeability changes with the gastrointestinal tract.