INCREASED ABSORPTION OF POLYSUCROSE, A MARKER OF INTESTINAL PARACELLULAR PERMEABILITY, IN CROHNS-DISEASE

Objective: To examine whether synthetic polysucrose behaves as a transcellular or paracellular marker in patients with Crohn's disease and in healthy subjects. Design: Patients with Crohn's disease (n = 23) and age- and sex-matched healthy controls (n = 22) were given an oral dose of polysucrose with a mean molecular weight of about 15 kDa, administered with a standard meal. Methods: Intestinal permeability to polysucrose was estimated as urinary excretion of the compound measured by immunoassay during 0-4, 4-8 and 8-12 h. Results: Urinary excretion values for polysucrose in the controls had a non-symmetrical frequency distribution and were not correlated to urinary volume. For the Crohn's disease group, intestinal permeability to polysucrose was significantly increased for the intervals 4-8 h and 8-12 h (P < 0.05). Permeability was more increased in small intestinal disease than in colonic disease, and more increased in active than in quiescent disease; hence, in patients with active Crohn's disease of the small intestine, intestinal permeability to polysucrose was significantly increased for all three time intervals (0-4, P < 0.05; 4-8 h, P < 0.001; 4-12 h, P < 0.01). Peak urinary excretion of polysucrose occurred later in the Crohn's disease patients than in the controls. Conclusions: Intestinal permeability to polysucrose is increased in Crohn's disease. In Crohn's disease patients and in healthy controls, polysucrose behaves as earlier described for known markers of paracellular intestinal permeability such as Cr-51-ethylenediamine tetraacetic acid (Cr-51-EDTA) and lactulose. We conclude that polysucrose, which has the advantage of being both non-radioactive and resistant to bacterial degradation, may be used as such a marker.