TY - JOUR
T1 - Rhamnose Is Superior to Mannitol as a Monosaccharide in the Dual Sugar Absorption Test
T2 - A Prospective Randomized Study in Children With Treatment-Naïve Celiac Disease
AU - Holtz, Lori R.
AU - Hoffmann, Julie
AU - Linneman, Laura
AU - He, Mai
AU - Smyrk, Thomas C.
AU - Liu, Ta Chiang
AU - Shaikh, Nurmohammad
AU - Rodriguez, Cynthia
AU - Dyer, Roy B.
AU - Singh, Ravinder J.
AU - Faubion, William A.
N1 - Funding Information:
This work was supported in part by the Bill & Melinda Gates Foundation (OPP1066153), the Children's Discovery Institute (MD-FR-2013-292), and P30DK052574 (for the Biobank Core). Study sponsors had no role in study design, collection, analysis, and interpretation of data, writing of this report, or the decision to submit for publication.
Funding Information:
WF consults for MediBeacon without personal compensation. T-CL consults for Interline Therapeutics and holds a research grant from Pfizer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher Copyright:
Copyright © 2022 Holtz, Hoffmann, Linneman, He, Smyrk, Liu, Shaikh, Rodriguez, Dyer, Singh and Faubion.
PY - 2022/4/7
Y1 - 2022/4/7
N2 - Background and Aim: We sought to correlate two different measures of gut permeability [lactulose:mannitol (L:M) and lactulose:rhamnose (L:R)] to the severity of duodenal histopathology in children with and without elevated antibodies to tissue transglutaminase (tTG). A secondary objective was to correlate gut permeability with celiac disease (CD) serology and indices of inflammation and bacterial product translocation. Methods: We prospectively randomized children undergoing endoscopy with abnormal (n = 54) and normal (n = 10) concentrations of circulating antibodies to tTG, to either L:M or L:R. Biopsies underwent modified Marsh scoring to measure mucosal injury. Circulating anticore Escherichia coli lipopolysaccharide (LPS) IgG, α-1 acid glycoprotein, LPS-binding protein, and C-reactive protein concentrations were measured by enzyme immunoassays. Results: Of the 54 cases with positive celiac serology, 31 and 69% had modified Marsh 0/1 scores or ≥3a, respectively. Circulating tTG IgA correlated with the modified Marsh score (p = 0.03). L:R, but not L:M or percent L excreted, differed according to modified Marsh scores (p = 0.01). There was no significant association between any systemic marker of inflammation or gut injury, and modified Marsh scores. Concerningly, most participants had evidence of urinary M before the challenge sugar was administered. Conclusions: L:R, but not L:M, is associated with modified Marsh scores in children undergoing small bowel biopsy for suspected CD. Despite increased intestinal permeability, we see scant evidence of systemic exposure to gut microbes in these children. Gut permeability testing with L:R may predict which patients with abnormal celiac serology will have biopsy evidence for celiac disease and reduce the proportion of such patients undergoing endoscopy whose Marsh scores are ≤1. M should not be used as a monosaccharide for permeability testing in children.
AB - Background and Aim: We sought to correlate two different measures of gut permeability [lactulose:mannitol (L:M) and lactulose:rhamnose (L:R)] to the severity of duodenal histopathology in children with and without elevated antibodies to tissue transglutaminase (tTG). A secondary objective was to correlate gut permeability with celiac disease (CD) serology and indices of inflammation and bacterial product translocation. Methods: We prospectively randomized children undergoing endoscopy with abnormal (n = 54) and normal (n = 10) concentrations of circulating antibodies to tTG, to either L:M or L:R. Biopsies underwent modified Marsh scoring to measure mucosal injury. Circulating anticore Escherichia coli lipopolysaccharide (LPS) IgG, α-1 acid glycoprotein, LPS-binding protein, and C-reactive protein concentrations were measured by enzyme immunoassays. Results: Of the 54 cases with positive celiac serology, 31 and 69% had modified Marsh 0/1 scores or ≥3a, respectively. Circulating tTG IgA correlated with the modified Marsh score (p = 0.03). L:R, but not L:M or percent L excreted, differed according to modified Marsh scores (p = 0.01). There was no significant association between any systemic marker of inflammation or gut injury, and modified Marsh scores. Concerningly, most participants had evidence of urinary M before the challenge sugar was administered. Conclusions: L:R, but not L:M, is associated with modified Marsh scores in children undergoing small bowel biopsy for suspected CD. Despite increased intestinal permeability, we see scant evidence of systemic exposure to gut microbes in these children. Gut permeability testing with L:R may predict which patients with abnormal celiac serology will have biopsy evidence for celiac disease and reduce the proportion of such patients undergoing endoscopy whose Marsh scores are ≤1. M should not be used as a monosaccharide for permeability testing in children.
KW - Marsh score
KW - celiac disease
KW - dual sugar absorption test
KW - intestinal permeability
KW - tissue transglutaminase
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UR - http://www.scopus.com/inward/citedby.url?scp=85128694549&partnerID=8YFLogxK
U2 - 10.3389/fped.2022.874116
DO - 10.3389/fped.2022.874116
M3 - Article
AN - SCOPUS:85128694549
SN - 2296-2360
VL - 10
JO - Frontiers in Pediatrics
JF - Frontiers in Pediatrics
M1 - 874116
ER -