Evaluation of intestinal permeability by triple sugar test in patients with autoimmune liver diseases

Abstract

We evaluated intestinal permeability by triple sugar test in patients with autoimmune liver diseases. Patients were divided into groups with autoimmune hepatitis, primary biliary cholangitis and overlap syndrome (autoimmune hepatitis/primary biliary cholangitis). 102 people were included in the cross-sectional study: 72 patients with autoimmune liver diseases and 30 healthy volunteers. Diagnose based on recommendations — EASL (2017), AASLD (2019), IAIHG (2021). Small intestine permeability was evaluated by the ratio of lactulose/mannitol in urine, large bowel permeability by the level of sucralose in urine (nmol/l). We used the method of high-performance liquid chromatography–mass spectrometry. Patients with autoimmune liver diseases had increased small intestine permeability – 0.12 [0.07; 0.234] (p < 0.001) compared to the control group — 0.013 [0.01; 0.025]. Large bowel permeability — 760.8 [386.4; 1640] nmol/l did not differ from group control — 785.6 [408; 1027.2]. Increased small intestine permeabilityin patients with autoimmune liver diseases: stage of hepatitis — 0.17 [0.118; 0.253] (p < 0.001), liver cirrhosis — 0.106 [0.07; 0.23] (p < 0.001) compared with the control group. Large bowel permeability in patients with hepatitis and in liver cirrhosis did not differ from control group. Increased values of the triple sugar test were detected in patients with autoimmune hepatitis (increased permeability of the small intestine (0,09 [0,07; 0,17] (p < 0.05), increased permeability of large bowel — 1091,2 [760; 2352] (p < 0.05)) and overlap syndrome (increased small intestine permeability — 0.18 [0,086; 0,3] (p < 0,05) and increased large bowel permeability — 880 [424; 1680] (p < 0,05)) at the stage of liver cirrhosis. Patients with autoimmune liver diseases show the increased permeability of the small intestine. The presence of increased permeability of the small and large intestine may indicate the progression of the disease.