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Research Project: Microbiota and Nutritional Health

Location: Children's Nutrition Research Center

Title: Gut permeability is affected by sex and increased in children with irritable bowel syndrome but not in functional abdominal pain

item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)
item DEVARAJ, SRIDEVI - Baylor College Of Medicine
item HEITKEMPER, MARGARET - University Of Washington

Submitted to: Neurogastroenterology & Motility
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/30/2019
Publication Date: 12/9/2019
Citation: Shulman, R.J., Devaraj, S., Heitkemper, M. 2019. Gut permeability is affected by sex and increased in children with irritable bowel syndrome but not in functional abdominal pain. Neurogastroenterology & Motility. 32(3):e13765.

Interpretive Summary: There is growing interest in understanding how sex influences health and disease. The strength of the lining of the gastrointestinal (GI) tract plays a critical role in protecting the body from things in the diet that can cause illness. In this study we discovered that the strength of the GI tract lining differs between girls and boys with the common disorder, irritable bowel syndrome (IBS). Further, sex influences the strength of the lining in different parts of the GI tract. These results stress the importance of sex on the function of the GI tract in children.

Technical Abstract: Gut permeability is increased in some children and adults with irritable bowel syndrome (IBS). We investigated whether this also is true for children with functional abdominal pain (FAP). We also determined whether sex affected permeability results. Sucrose, lactulose, mannitol, and sucralose were ingested after an overnight fast in well-phenotyped children with IBS (n = 95), FAP (n = 25), and healthy controls (HC) (n = 60). Urine was collected for 24 hours. Percent sucrose recovery was calculated based on the 0- to 3-hour collection; lactulose/mannitol ratio both on the 0- to 3-hour and 0- to 24-hour collections; and percent sucralose recovery on the 0- to 24-hours collection. Age was similar among the groups (P = .26). The lactulose/mannitol ratio was increased in IBS compared with HC at 0-3 and 0-24 hours (P = .023, P = .05, respectively). Percent sucralose recovery was greater in FAP than in HC (P = .045). No differences were noted among the groups in percent sucrose recovery. Taking sex into account, percent sucrose recovery was greater in girls with IBS vs HC girls (P = .008). The lactulose/mannitol ratio was greater in boys with IBS compared with HC boys at both time points (both P = .02). Percent sucralose recovery was greater in boys with IBS than in FAP or HC (both P < .001). Sex is a critically important factor when measuring gut permeability. Boys with IBS have increased lactulose/mannitol ratios and percent sucralose recovery. Girls with IBS have increased percent recovery of sucrose. Children with FAP do not demonstrate abnormal gut 0permeability even taking sex into account.