Valentina Giorgio1, Luca Miele2, Luigi Principessa3, Francesca Ferretti1, Maria Pia Villa3, Valentina Negro3, Antonio Grieco4, Anna Alisi1, Valerio Nobili5. 1. Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy. 2. Clinical Division of Internal Medicine, Gastroenterology and Liver Unit, Complesso Integrato Columbus Hospital, Catholic University of Rome, Italy; Institute of Internal Medicine, Catholic University of Rome, Italy. 3. Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy. 4. Clinical Division of Internal Medicine, Gastroenterology and Liver Unit, Complesso Integrato Columbus Hospital, Catholic University of Rome, Italy. 5. Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy. Electronic address: nobili66@yahoo.it.
Abstract
BACKGROUND: Increased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression. AIM: To investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease. METHODS: We performed a case-control study examining intestinal permeability in children using the lactulose-mannitol bowel permeability test. RESULTS: Overall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038±0.037 vs. 0.008±0.007, p<0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05±0.04 vs. 0.03 vs. 0.03, p<0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p=0.02), fibrosis (p=0.0002), and ballooning of hepatocytes (p=0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27±0.68 vs. 2.80±0.35, p<0.05). CONCLUSIONS: Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.
BACKGROUND: Increased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression. AIM: To investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease. METHODS: We performed a case-control study examining intestinal permeability in children using the lactulose-mannitol bowel permeability test. RESULTS: Overall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038±0.037 vs. 0.008±0.007, p<0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05±0.04 vs. 0.03 vs. 0.03, p<0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p=0.02), fibrosis (p=0.0002), and ballooning of hepatocytes (p=0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27±0.68 vs. 2.80±0.35, p<0.05). CONCLUSIONS: Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.
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