Digestive Diseases and Sciences

, Volume 56, Issue 1, pp 161–169 | Cite as

Abnormal Small Intestinal Permeability in Patients with Idiopathic Malabsorption in Tropics (Tropical Sprue) Does Not Change Even After Successful Treatment

  • Sunil Kumar
  • Uday C. Ghoshal
  • Kamaiah Jayalakshmi
  • Raja Roy
  • Asha Misra
  • C. L. Khetrapal
Original Article



Though tropical sprue (TS) is common in tropics, studies on small intestinal permeability (SIP) in TS are scant.


SIP was evaluated using 1H nuclear magnetic resonance (NMR) spectroscopy of urinary lactulose and mannitol in 24 patients with TS (22 before and 15 after treatment with tetracycline and folate) and in 31 healthy subjects (HS). Effect of treatment of TS on SIP and its relationship with outcome were studied.


Subjects were comparable in terms of age and gender. Before treatment, urinary lactulose (0.24 mmol, 0–1.09 mmol versus 0.09 mmol, 0–0.68 mmol, P = 0.02) and lactulose-to-mannitol (L/M) ratio (0.11, 0–0.41 versus 0.042, 0–0.26, P = 0.001) were higher in TS than in HS, though mannitol was comparable (2.7 mmol, 0.61–10.5 mmol versus 3.8 mmol, 1.3–16.4 mmol, P = 0.08). Patients improved after treatment [stool frequency (9, 4–20/day versus 1, 1–2/day, P < 0.0001), weight (44.4, 32–69 kg, versus 56, 39–84 kg, P < 0.0001), fecal fat (10.1, 6–26 g/24 h versus 4.4, 3.0–6.7 g/24 h, P < 0.0001), d-xylose (0.57, 0.28–1.2 g/5 g/5 h versus 1.1, 0.2–2.1 g/5 g/5 h, P < 0.0001), and small intestinal bacterial overgrowth (SIBO) resolved in 10/24 (41.7%) versus 1/15 (6.6%), P = 0.02]. Though urinary lactulose (0.17, 0–4.3 mmol versus 0.09, 0–0.68 mmol, P = 0.11) and mannitol (2.17, 0.8–36.7 mmol versus 3.84, 1.3–16.4 mmol, P = 0.06) were comparable, L/M ratio was higher in TS than in HS (0.09, 0–0.22 versus 0.042, 0–0.26, P = 0.002). L/M ratio was more often abnormal (cutoff 0.078) in TS than in HS [14/22 (63.6%) versus 3/31 (9.7%); P = 0.0001], which persisted even after treatment [9/15 (60%) as compared with HS; P = 0.0006]. Persistently abnormal SIP was associated with less weight gain and frequent stools following treatment.


SIP is often abnormal in TS and remains unchanged even after successful treatment that was associated with less weight gain and more frequent stool.


Malabsorption syndrome Intestinal function Small intestinal permeability Lactulose mannitol test Tropical sprue 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sunil Kumar
    • 1
  • Uday C. Ghoshal
    • 1
  • Kamaiah Jayalakshmi
    • 2
  • Raja Roy
    • 2
  • Asha Misra
    • 1
  • C. L. Khetrapal
    • 2
  1. 1.Department of GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  2. 2.Centre of Biomedical Magnetic ResonanceSanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia

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