Gut Peptides and Intestinal Permeability in Celiac Disease and Irritable Bowel Syndrome

Azienda Ospedaliera Specializzata in Gastroenterologia Saverio de Bellis70 enrolled

Overview

It is well known that the intestinal barrier is altered in celiac disease (CD), an autoimmune disease that develops in genetically predisposed subjects exposed to ingestion of wheat gliadin and of related prolamines of barley and rye. More recently, defective epithelial barrier has been implicated in the pathogenesis of other conditions such as irritable bowel syndrome (IBS). At present IBS is still considered a functional condition although low-grade inflammation has been associated with its manifestation, particularly that following infection. Different substances have been implicated in the (dis)regulation of intestinal barrier, among them zonulin seems to play a key role. Other gastrointestinal peptides are GPL-2, Ghrelin, and Epidermal growth factor (EGF). In order to shed light on the hormonal regulation of intestinal barrier function in celiac patients before undergoing a gluten free diet and possible differences with those of IBS patients, in the present study the investigators will apply the non-invasive lactulose/mannitol permeability test toward the evaluation of intestinal damage. The pattern of intestinal permeability and the GI peptides concentration will be compared in celiac patients, IBS patients and healthy controls.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Celiac Disease Irritable Bowel Syndrome

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion criteria of celiac disease patients: * Diagnosis of CD was based on the detection of IgA antiendomysial and IgA antitissue transglutaminase antibodies in serum * Diagnosis must be confirmed by a small intestinal biopsy obtained at the time of gastrointestinal endoscopy. * All patients must show Marsh 3 grade villous atrophy at the time of the diagnosis. Inclusion criteria of IBS patients. * Subjects suffering from irritable bowel syndrome according to the Rome III criteria. * Availability of at least one GI imaging study during the last five years (colonoscopy, sigmoidoscopy, abdominal ultrasound, barium enema) Exclusion criteria for both the above groups: * None were taking anti-inflammatory drugs (including mast cell stabilisers, histamine antagonists, anticholinergics, anti-diarrhoea medication, probiotics, immunosuppressants and steroids) * Presence of organic syndrome, including food allergy, atopy and severe clinical depression or anxiety. * Abnormal laboratory data or thyroid function * Major abdominal surgery Healthy subjects will be recruited in the administrative staff of the Institute after thorough exclusion of GI symptoms.

Outcomes

Primary Outcomes

Plasma concentrations of GI peptides (Zonulin, GLP-2, Ghrelin and EGF)

Time frame: within one month after the enrollment

Secondary Outcomes

Intestinal permeability

The detection and measurement of two sugar probes, lactulose (La) and mannitol (Ma), in the urine will be performed by chromatographic analysis. For each sample the percentage of ingested La and Ma in urine will be evaluated and their ratio (La-Ma) will be calculated.