Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/3/2008
Publication Date: 11/1/2008
Citation: Shulman, R.J., Eakin, M.N., Czyzewski, D.I., Jarrett, M., Ou, C. 2008. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and Irritable Bowel Syndrome. Journal of Pediatrics. 153(5):646-650. Interpretive Summary: One of the most common problems in children is recurrent abdominal pain. Although diet plays a role in the symptoms in some children, the changes in the gastrointestinal (GI) tract that account for the problem are unknown. In this study we compared the integrity of the GI tract in children with recurrent abdominal pain to those without GI symptoms. We also measured the amount of inflammation in the GI tract. We found that as a group, children with recurrent abdominal pain have impaired GI integrity and low-grade inflammation. The amount of inflammation was related to how often the pain interfered with their activities. These results have important implications for understanding the cause and treatment of recurrent abdominal pain.
Technical Abstract: To determine gastrointestinal (GI) permeability and fecal calprotectin concentration in children 7 to 10 years of age with functional abdominal pain and irritable bowel syndrome (FAP/IBS) versus control subjects and ascertain potential relationships with pain symptoms and stooling, GI permeability and fecal calprotectin concentration were measured. Children kept a 2-week diary of pain episodes and stooling pattern. Proximal GI permeability was greater in the FAP/IBS group (n = 93) compared with control subjects (n = 52) (0.59 +/- 0.50 vs 0.36 +/- 0.26, respectively; mean +/- SD; P < .001) as was colonic permeability (1.01 +/- 0.67 vs 0.81 ±+/-0.43, respectively; P < .05). Gastric and small intestinal permeability were similar. Fecal calprotectin concentration was greater in children with FAP/IBS compared with control children (65.5 ± 75.4 micro g/g stool vs 43.2 +/- 39.4, respectively; P < .01). Fecal calprotectin concentration correlated with pain interference with activities (P = .01, r2 = 0.36). There was no correlation between GI permeability and pain-related symptoms. Neither permeability nor fecal calprotectin correlated with stool form. Children with FAP/IBS have evidence of increased GI permeability and low-grade GI inflammation, with the latter relating to the degree to which pain interferes with activities.