Intestinal Hyperpermeability, Causes and Clinical Correlations

Gastrointestinal tract is a continuous tubular structure from the mouth to the anus.

It is lined by epithelial cells.

These epithelia form a protective barrier.

This Barrier Plays an Important Role in:

• Absorption of fluids, electrolytes and nutrition.

• Protection from toxic and infective agents and also from antigens. When the indigenous bacteria in the intestines start invading the body and deposit in tissues outside the intestines like lymph nodes, spleen, liver etc., they may contribute to multiple organ involvement and sometimes organ failure.

• Secretion of antibodies mainly IgA, thereby protecting the body from bacterial invasion. The IgA antibodies secreted in the intestines attach to the bacteria. This does not allow the bacteria to get attached to the gut wall. A reduction in the secretion of the IgA antibodies causes increased intestinal permeability and allows the bacteria to cross the epithelial lining and into the intestinal wall.

• Formation of “tight junctions”. These are fused area between the cells of the epithelia that control the absorption and protection. These junctions are variable and can keep changing.

Intestinal Permeability in Infants:

• This barrier formed by the epithelial cells is incomplete and immature at birth and takes up to two years of age to start being effective.

• So, an infant’s epithelia are more permeable.

• Therefore more harmful substances can cross over to the body especially if the solid diet is started prior to the completion and maturation of this barrier.

• This along with inheritance may be a major cause of food allergies in children.

• It is for this reason that exclusive breast feeding is recommended till six months of age and then during weaning, food items that are common allergens like cow’s milk, wheat, and eggs are best avoided.

• During weaning, avoiding foods that have high chances of allergy is more significant in children who have a history of atopy or have at least one parent with a history of atopy (genetically inherited tendency to develop allergies).

Conditions and diseases associated with altered intestinal permeability are acute gastroenteritis, alcoholism, ankylosing spondylitis, arthritis, asthma, burn injury, celiac disease, crohn’s disease, cystic fibrosis, eczema, endotoxemia, food allergy, HIV AIDS, use of NSAIDs, pancreatic dysfunction, rheumatoid arthritis, schizophrenia, surgery, trauma, ulcerative colitis, and urticaria.

Causes of Intestinal Hyperpermeability are:

• Drugs - lot of drugs make one susceptible to this condition. The most prominent are NSAIDs (or painkillers), chemotherapeutic agents, antibiotics, oestrogen, cocaine etc.

• Gastroenteritis - inflammation of the stomach and intestines. This may be due to bacterial or viral involvement.

• Alcoholism - small intestinal tight junctions are affected by chronic consumption of alcohol thereby causing intestinal hyperpermeability.

• Radiation especially of abdominal region - oxygen radicals formed during the treatment may easily overcome the antioxidant mechanisms of the body.

• Trauma and surgeries - this may be due to utilization of glutamine (amino acid found in abundance in the body).

• Enteral (providing nutrition directly into the stomach through some device) and total parenteral nutrition (nutritional support through the vein) - this causes intestinal hyperpermeability due to bacterial overgrowth.

Clinical Correlations of Intestinal Hyperpermeability with other diseases:

• Inflammatory bowel disease - the intestinal wall is damaged and ulcerated thereby allowing passage of antigenic material across the gut wall and aggravating the condition.

• Celiac disease - it shows increased permeability of larger molecules while causing the malabsorption (abnormality in the absorption) of smaller molecules.

• Food allergy - intestinal hyperpermeability along with genetic inheritance may be a major cause of food allergies.

• HIV AIDS - there is associated villous atrophy (erosion of tiny structures that help in nutrient absorption), malabsorption and intestinal permeability.

• Ankylosing spondylitis - many people have been found to have associated increased intestinal permeability.

• Rheumatoid arthritis - significantly high levels of IgG to Proteus bacteria are found. The bacterial overgrowth leads to increased intestinal permeability.

• Asthma and atopic dermatitis - intestinal permeability is found to be increased.

• Urticaria - association found to food allergies.

Treatment for Intestinal Hyperpermeability:

• Glutamine, chiefly produced in lungs and skeletal muscles and primarily used in intestines needs to be supplemented.

• Dietary fibre supplementation is essential.

• Fish oils are found to be beneficial in view of their omega 3 fatty acids.

• Lactobacilli and Saccharomyces boulardii are both essential to boost the host immunity.

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