Intestinal permeability test as a predictor of clinical course in Crohn's disease

Am J Gastroenterol. 1999 Oct;94(10):2956-60. doi: 10.1111/j.1572-0241.1999.01444.x.


Objective: The clinical course of Crohn's disease is often unpredictable. The aim of this study was to select the most useful parameters able to predict clinical relapses.

Methods: One hundred-thirty Crohn's disease patients in clinical remission were followed every 4 months for 2 yr or until clinical relapse. Demographic and clinical data were recorded and intestinal permeability (lactulose/mannitol [L/M] test) and biochemical tests (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, alpha1 acid glycoprotein, and serum iron) were performed at study entry. A subgroup of 54 patients had clinical follow-up and repeated tests every 4 months.

Results: Fifty-two patients (40%) relapsed during the 2-yr follow-up. A significant correlation was found between relapse and gender (p = 0.030) but not between relapse and age, extent and type of disease, previous surgery, or therapy. Increased L/M test (p = 0.0001) and decreased serum iron level (p = 0.0057) were associated with clinical relapse. Time-dependent analysis, performed on patients receiving serial evaluation, showed that L/M test alteration was the only variable that could predict a relapse (RR 8.84, 95% confidence interval [CI] 1.41-53.37; p < 0.05).

Conclusions: The L/M test identifies Crohn's disease patients in apparent remission, but with a high risk of clinical relapse, better than clinical and biochemical indices. Different treatment strategies might be suggested for this subgroup of patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biomarkers / analysis
  • Blood Sedimentation
  • C-Reactive Protein / analysis
  • Crohn Disease / diagnosis*
  • Crohn Disease / metabolism
  • Female
  • Humans
  • Intestinal Mucosa / metabolism*
  • Lactulose
  • Leukocyte Count
  • Male
  • Mannitol
  • Middle Aged
  • Orosomucoid / analysis
  • Permeability
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Recurrence


  • Biomarkers
  • Orosomucoid
  • Mannitol
  • Lactulose
  • C-Reactive Protein