Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: 1/23/2007
Publication Date: 2/4/2007
Citation: Shulman, R.J., Czyzewski, D., Jarrett, M.E., Zeltzer, L. 2007. Abnormal gastric and colonic permeability in children with recurrent abdominal pain (RAP) [abstract]. Gastroenterology. 132(Supl.2):A65. Interpretive Summary:
Technical Abstract: Recent histologic studies have suggested evidence of low grade inflammation in many patients with irritable bowel syndrome (IBS). Additionally, small intestinal permeability recently has been reported to be abnormal in some adults with IBS. Whether the same is true for children with RAP, a condition that affects 10-15% of school age children and bears many similarities to IBS in adults has received little attention. Children (age 7-10 yr.) were identified by chart review in pediatrician’s or pediatric gastroenterologist’s offices. Children with RAP (n=70) met Rome II criteria for functional abdominal pain or IBS. Non-RAP healthy Control subjects (n=31) were recruited through the same pediatrician’s offices. Phone screening confirmed current symptoms. After instruction in the home by research assistants the children underwent measurement of gastrointestinal permeability using sucrose (S), lactulose (L), mannitol (M), and sucralose (Sucra) to measure gastric (S/L ratio), small intestinal (L/M ratio), and colonic permeability (Sucra/L ratio). Children also kept a 2-wk diary to record pain frequency and severity and number and character of stools. There were no differences between groups in age (RAP: 8.5 +/- 0.1 vs. C: 8.7 +/- 0.1; mean +/- SEM). Gastric and colonic permeability were significantly greater in children with RAP than in Controls. No differences were detected in small intestinal permeability. Mean pain score, maximum reported pain, and number of pain episodes also were greater in RAP than in Controls. Number of stools and stool consistency (watery, mushy, formed, hard balls) were similar between the groups. There was no relationship between gastric, small intestinal, or colonic permeability and pain or stool reports for the groups combined or separately. We conclused that: 1) Children with RAP have evidence of gastric and colonic injury; 2) Pain and stooling pattern do not appear to be related directly to intestinal permeability; 3) Abnormal intestinal permeability does not appear to play a significant role in pain and bowel symptoms in children with RAP.