Journal of Gastroenterology

, Volume 49, Issue 11, pp 1467–1476

Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome


    • Department of PediatricsBaylor College of Medicine, Children’s Nutrition Research Center, and Texas Children’s Hospital
  • Monica E. Jarrett
    • Department of Biobehavioral Nursing and Health SystemsUniversity of Washington
  • Kevin C. Cain
    • Department of Biostatistics and Office of Nursing ResearchUniversity of Washington
  • Elizabeth K. Broussard
    • Department of MedicineUniversity of Washington
  • Margaret M. Heitkemper
    • Department of Biobehavioral Nursing and Health SystemsUniversity of Washington
Original Article—Alimentary Tract

DOI: 10.1007/s00535-013-0919-6

Cite this article as:
Shulman, R.J., Jarrett, M.E., Cain, K.C. et al. J Gastroenterol (2014) 49: 1467. doi:10.1007/s00535-013-0919-6



Alterations in gastrointestinal (GI) permeability and immune measures are present in some patients with irritable bowel syndrome (IBS) but the relationship to symptoms is poorly defined. In adults with IBS, we compared permeability, unstimulated peripheral blood monocyte (PBMC) interleukin-10 (IL-10) levels, IBS life interference, and GI and psychological distress symptoms.


In 88 women and 18 men with IBS, GI permeability was quantitated as percent recovery of urinary sucrose and the lactulose/mannitol (L/M) ratio. IL-10 was measured in supernatants from 72-h incubated, unstimulated PBMCs. Participants completed a 4-week daily diary recording IBS life interference on daily activities and work, IBS symptoms, and psychological distress symptoms. They also completed the Brief Symptom Inventory.


The L/M ratio but not percent sucrose recovery was significantly correlated with IBS interference with activities and work and retrospectively measured anxiety and depression. Unstimulated PBMC production of IL-10 correlated significantly with IBS interference with daily work, IBS symptom score, and abdominal pain. We identified a subgroup of IBS subjects with higher IL-10 and/or higher L/M ratio who had substantially higher IBS interference and IBS symptom scores.


Our findings suggest a distinct subgroup of IBS patients with alterations in gut barrier function. This subgroup is characterized by increased GI permeability and/or increased PBMC production of IL-10. These physiologic alterations reflect more severe IBS as measured by interference of IBS with daily activities and daily IBS symptoms.


PermeabilityCytokineSymptomsIrritable bowel syndrome

Supplementary material

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Supplementary material 1 (DOCX 30 kb)
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Supplementary material 2 (DOCX 30 kb)

Copyright information

© Springer Japan 2014