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Lactulose Mannitol Test and Intestinal Permeability





Dig Dis Sci. 2008 Mar 5 [Epub ahead of print]


Lactulose/Mannitol Test and Specificity, Sensitivity, and Area under Curve of Intestinal Permeability Parameters in Patients with Liver Cirrhosis and Crohn's Disease.


Dastych M, Dastych M Jr, Novotná H, Cíhalová J. Department of Clinical Biochemistry and Hematology, University Hospital Brno, Jihlavská 20, 62500, Brno, Czech Republic, This email address is being protected from spambots. You need JavaScript enabled to view it..



The purpose of this study was to investigate and compare the specificity, sensitivity, and area under curve (AUC) of the lactulose/mannitol ratio, lactulose/creatinine ratio, and lactulose recovery and their diagnostic value for intestinal permeability assessment within the absorption lactulose/mannitol (L/M) test. Results The value of the lactulose/mannitol ratio, lactulose/creatinine ratio, and the percentage of lactulose recovery in Crohn's disease (0.0763 +/- 0.0369; 99.62 +/- 67.87; 1.0478 +/- 0.6148) and in liver cirrhosis (0.0517 +/- 0.0365; 54.65 +/- 53.26; 0.838 +/- 0.929) were significantly different from the values measured in the control group (0.0123 +/- 0.0081; 10.95 +/- 7.07; 0.2438 +/- 0.1568), P < 0.0001-0.002). In Crohn's disease, specificity, sensitivity, and AUC were 100%, 89.5%, and 0.987, respectively, of the lactulose/mannitol ratio at a cut-off level of 0.022. In liver cirrhosis, the test characteristics were 88.5%, 84.2%, and 0.910 at a cut-off level of 0.018. Conclusion The lactulose/mannitol ratio was evaluated to have the highest diagnostic value to assess intestinal permeability.









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People in this conversation

  • Guest - Christine

    The results from my Intestinal Permeability test were 1.28 for Lactulose recovery, 41 for Mannitol recovery and .03 for the ratio of Lactulose/Mannitol. I understand that this means that I am still showing permeability of small antigens across the intestinal wall. I have been on a strict diet for the foods tested that I show some antibody production. My question is: what does this mean exactly? Is there still enough inflammation that the intestinal wall is able to pass small particles and would that be of any food? Or are there just some foods that are of a size that are getting through? Presently, I am avoiding dairy, eggs, gluten, soy, grains, sugars (except for honey), legumes, and nightshades. I have just started eating small amounts of fish as that showed up on my intolerance test at first as well, but we have been trying to add back a few foods since I am so limited. I also show positive for SIBO so I have been following the SCD diet. I feel I am over eating nuts and fruit to compensate for lack of a fast kind of snack pick up. Thanks for any explanations. Christine

  • Hi Robyn,

    Yes you're correct that your lactulose result is slightly high. What this means is that you likely have a mild case of leaky gut syndrome.

    High lactulose results mean that large particles from your gut are passing between the cells that line the intestines and being absorbed into your body. These particles could be incompletely digested food or gut microbes such as the common yeast Candida, or various species of bacteria (either whole or parts of dead organisms). The result is that your immune system will react to all of this stuff entering your system and cause inflammatory reactions. Increased intestinal permeability (leaky gut syndrome) has been associated with many allergic and autoimmune disorders such eczema and rheumatoid arthritis. The absorption of these things that should remain in your gut also puts extra strain on your liver which has to detoxify all the extra toxins absorbed. An overloaded liver can cause symptoms from digestive upsets to fatigue and generally feeling unwell.

    It is best to work with a nutritionally oritentated doctor or an alternatibe medicine practitioner (naturopath, nutritionist, herbalist) to help you treat this problem.

    Please start by having a look at the [URL=]leaky gut syndrome treatment[/URL] page on this site and search elsewhere on the internet. There is a lot of information out there. Good luck!

  • Hi Ann,

    Tests for leaky gut syndrome (or "increased intestinal permeability") are not widely used by conventional doctors as yet so are not provided on a local level. There are a number of labs in the US however that do provide the Lactulose/Mannitol Assessment to test for leaky gut syndrome. The one I am most familiar with is Genova Diagnostics (formerly Great Smokies Diagnostic Lab). The page on their website for the Lactulose/Mannitol Assessment is at - [url][/url]

    All you do for the test is collect a few urine samples before and after drinking a solution containing lactulose and mannitol, then post the samples to the lab. You will most likely need to find a doctor, nutritionist, or other alternative medicine practitioner in your area who is already familiar with the lab and the test. You can check the Health Care Professional Directory or post in the forums to see if any other visitors know of someone in your area.

    Hope this helps!

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