Investigation ofintestine function during acuteviral hepatitis using combined sugaroral loads

SUMMARY Onefifth ofall casesofA virus hepatitis (AVH)havesymptomsofgastroenteritis atthe onset.Thisstudyinvestigated themediated intestinal absorption ofD-xylose (D-xyl) and 3-o-methyl-D-glucose (3-omG) andthenon-mediated permeation oflactulose (Lacl, molwt342) andL-rhamnose (L-rh, molwt164)during acuteandremission phases ofAVH.Tenpatients with AVH were given anoral loadcontaining these sugars(5gD-xyl: 2*5g3-omG,1gL-rh, 5 glacl in 250mlwater) once during theacutephaseandagain during remission. Thesame load was given once toa group of22healthy controls. Themean concentration ofD-xylinurine andtheratio of D-xyl to3-omGinplasma andurine were normalinboththeAVH phases, ruling outintestinal malabsorption even intheacutephase. Thisstudy showed asignificant increase innon-mediated permeation toLacl, butnottoL-rh, during theacutephase. Thesedataindicate thatthebarrier function oftheintestine iscompromised inAVH infection while theabsorptive function isnot.An abnormally lowconcentration ofD-xyl and3-omGinplasma atone hour was foundinall patients during theacutephase. Thisfinding cannotbeexplained byalterations inintestinal absorption, but could beaccounted forbyincreased spacedistribution ofthesugarsbecause ofincreased diffusion into tissue cells and/or expansion oftheextracellular spacebyfluid retention.