Gastroduodenal permeability in Crohn's disease

Abstract

Background: Gastric permeability was prospectively investigated by determination of sucrose excretion in 100 patients with Crohn's disease. Results were compared with histological findings and the lactulose–mannitol ratio as a measure of intestinal permeability.Methods: All subjects underwent oesophagogastroduodenoscopy with biopsies of all investigated parts. Thirty‐two Helicobacter pylori‐positive patients were excluded from further analyses.Results: Gastroduodenal permeability was significantly higher in patients with Crohn's disease than in control subjects (P < 0.00001). Sucrose excretion alone did not predict microscopic inflammation of the upper gastrointestinal tract. Increased gastroduodenal permeability with a concomitant rise in intestinal permeability predicted histological upper gastrointestinal involvement of Crohn's disease with a likelihood of 86%. The negative predictive value was 43%.Conclusion: In parallel with findings in the small intestine, gastroduodenal permeability is increased in a high proportion of patients with Crohn's disease. In patients with an increased lactulose–mannitol ratio, elevated sucrose excretion is highly predictive of histological gastroduodenal involvement.