SynthesisBMC gastroenterology2022
A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn's disease.
Synthesis in BMC gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 34 citations in OpenAlex.
- A (poly)phenol-rich diet reduces serum and faecal calprotectin in older adults with increased intestinal permeability: the MaPLE randomised controlled trial.BMC geriatrics · 2024Trial
- Innovative Metasurface Colorimetric Cell-on-a-Chip Sensor for Continuous, Label-Free, Non-Destructive Assessment of Intestinal Barrier Dynamics.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Standardizing Intestinal Permeability Assessment: Optimization of Gluten Dose and Urine Collection Times for u-GIP and Lactulose:Mannitol Ratio in Healthy Volunteers.International journal of molecular sciences · 2026Article
- Small-fibre neuropathy in coeliac disease: a cross-sectional study.Frontiers in neurology · 2026Article
- Interplay between volemic balance and the intestinal tract: insights on biomarkers and diagnostic tests used to assess intestinal morphofunctional barrier.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas · 2026Review
- Article
- The epithelial barrier theory proposes a comprehensive explanation for the origins of allergic and other chronic noncommunicable diseases.FEBS letters · 2025Review
- Measuring Intestinal Barrier Permeability by Detecting Flux of Fluorescent Tracers Across Human Colonoid Monolayers.Journal of visualized experiments : JoVE · 2025Article
- Recent advances in the diagnosis of celiac disease.World journal of gastroenterology · 2025Article
- Intestinal Permeability In Vivo in Patients With Inflammatory Bowel Disease: Comparison of Active Disease and Remission.Inflammatory bowel diseases · 2025Article
- Markers of Gut Health in Small Animals: Focus on Fatty Acids and Amino Acids as Indicators of Intestinal Functionality and Microbiome Activity.Animals : an open access journal from MDPI · 2025Review
- Examining intraindividual variability of urinary gluten immunogenic peptides compared to the lactulose-mannitol ratio in healthy volunteers: implications for clinical assessment of intestinal permeability.Frontiers in immunology · 2025Article
- Quantifying lactulose and mannitol using LC-MS/MS in a clinical study of children with environmental enteric disease.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologica · 2025Article
- Non-invasive fluorescence sensing reveals changes in intestinal barrier function and gastric emptying rate in a first-in-human study of Crohn's disease.Therapeutic advances in gastroenterology · 2025Article
- A Rapid and Reliable Spectrofluorimetric Method to Measure the Urinary Lactulose/Mannitol Ratio for Dysbiosis Assessment.Biomedicines · 2024Article
- Guidelines for best practices in monitoring established coeliac disease in adult patients.Nature reviews. Gastroenterology & hepatology · 2024Review
- Transcutaneous fluorescence spectroscopy: development and characterization of a compact, portable, and fiber-optic sensor.Journal of biomedical optics · 2024Article
- Urinary excretion of gluten immunoreactive peptides as an indicator of gastrointestinal function after fasting and dietary provocation in healthy volunteers.Frontiers in immunology · 2024Article
- First-in-Human Assessment of Gut Permeability in Crohn's Disease Patients Using Fluorophore Technology.Gastro hep advances · 2024Article
- A cross-sectional study of correlations among blood-based biomarkers for intestinal permeability: A pilot study of United States veterans with posttraumatic stress disorder symptoms.Brain, behavior, & immunity - health · 2023Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained across studies. This meta-analysis aims to determine LMR in healthy subjects, coeliac and Crohn's disease.
methodsA literature search was performed using PRISMA guidance to identify studies assessing LMR in coeliac or Crohn's disease. 19 studies included in the meta-analysis measured gut permeability in coeliac disease, 17 studies in Crohn's disease. Outcomes of interest were LMR values and comparisons of standard mean difference (SMD) and weighted mean difference (WMD) in healthy controls, inactive Crohn's, active Crohn's, treated coeliac and untreated coeliac. Pooled estimates of differences in LMR were calculated using the random effects model.
resultsPooled LMR in healthy controls was 0.014 (95% CI: 0.006-0.022) while pooled LMRs in untreated and treated coeliac were 0.133 (95% CI: 0.089-0.178) and 0.037 (95% CI: 0.019-0.055). In active and inactive Crohn's disease, pooled LMRs were 0.093 (95% CI: 0.031-0.156) and 0.028 (95% CI: 0.015-0.041). Significant differences were observed in LMR between: (1) healthy controls and treated coeliacs (SMD = 0.409 95% CI 0.034 to 0.783, p = 0.032), (2) healthy controls and untreated coeliacs (SMD = 1.362 95% CI: 0.740 to 1.984, p < 0.001), (3) treated coeliacs and untreated coeliacs (SMD = 0.722 95% CI: 0.286 to 1.157, p = 0.001), (4) healthy controls and inactive Crohn's (SMD = 1.265 95% CI: 0.845 to 1.686, p < 0.001), (5) healthy controls and active Crohn's (SMD = 2.868 95% CI: 2.112 to 3.623, p < 0.001), and (6) active Crohn's and inactive Crohn's (SMD = 1.429 (95% CI: 0.580 to 2.278, p = 0.001). High heterogeneity was observed, which was attributed to variability in protocols used across different studies.
conclusionThe use of gut permeability measurements in screening and monitoring of coeliac and Crohn's disease is promising. LMR is useful in performing this function with significant limitations. More robust alternative tests with higher degrees of clinical evidence are needed if measurements of gut permeability are to find widespread clinical use.
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