Intestinal Hyperpermeability - Causes and Clinical Correlations

Introduction

The gastrointestinal (GI) tract is a tube-like structure that extends from the mouth to the anus and is lined with a layer of specialized cells called epithelial cells. These cells have a crucial function in forming a protective barrier within the GI tract. This barrier serves several essential roles, including:

• 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 areas between the cells of the epithelia that control absorption and protection. These junctions are variable and can keep changing.

What Is Intestinal Hyperpermeability?

Intestinal hyperpermeability, also known as "leaky gut syndrome," is a condition characterized by increased permeability of the intestinal lining. Normally, the intestinal wall acts as a barrier, selectively allowing the absorption of nutrients while preventing harmful substances from entering the bloodstream. In the case of intestinal hyperpermeability, the tight junctions between the cells of the intestinal lining become compromised, leading to the leakage of undigested food particles, toxins, and bacteria into the bloodstream. This can trigger several immune responses and chronic inflammation throughout the body, potentially contributing to various health issues.

Intestinal Permeability in Infants:

• The 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 before 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 breastfeeding 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 a high chance of allergy is more significant in children who have a history of atopy or have at least one parent with a history of atopy (a genetically inherited tendency to develop allergies).

What Are the Conditions and Diseases Associated With Intestinal Hyperpermeability?

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.

What are the symptoms of intestinal hyperpermeability?

There is a wide range of symptoms associated which differs in each person with intestinal hyperpermeability. Some of them include:

• Digestive issues like chronic bloating, abdominal pain, gas, and discomfort.

• Food sensitivities like allergies, unexplained reactions, and intolerances to certain foods.

• Fatigue and low energy.

• Muscle aches and joint pains.

• Skin problems like hives, acne, rashes, or eczema.

• Autoimmune responses.

What Are the Causes of Intestinal Hyperpermeability?

• Drugs - A lot of drugs make one susceptible to this condition. The most prominent are NSAIDs (or painkillers), chemotherapeutic agents, antibiotics, estrogen, 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 the 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 the utilization of glutamine (an 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) - cause intestinal hyperpermeability due to bacterial overgrowth.

What Are the 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 - 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.

How Is Intestinal Hyperpermeability Treated?

The treatment for intestinal hyperpermeability aims to restore the integrity of the intestinal barrier

and address the underlying causes.

Dietary Modifications:

• Eliminating triggers such as gluten, processed foods, dairy, and refined sugars.

• Consuming a diet rich in fruits, vegetables, healthy fats, and lean proteins.

• Including gut-healing foods like bone broth, fermented foods, and high-fiber foods.

Nutritional Supplements:

• Probiotics to restore healthy gut bacteria.

• Glutamine supports gut cell regeneration.

• Omega-3 fatty acid helps in reducing inflammation.

• Vitamins and minerals support immune function and tissue repair.

Medications:

• Anti-inflammatory drugs.

• Immune-modulating medications.

• Antibiotics.

Other Treatment Approaches.

• Long-term stress can lead to intestinal hyperpermeability. Simple methods like mindfulness meditation, yoga, deep breathing, and regular exercise can help reduce stress and improve overall well-being.

• Treating any underlying health conditions, such as infections, autoimmune disorders, or imbalances in gut microbiota, can help restore intestinal health.

• Getting help from a healthcare professional to find and get rid of certain food sensitivities can help with symptoms and decrease inflammation.

Conclusion

In conclusion, while intestinal hyperpermeability can present significant challenges, there is hope for positive outcomes. With the help of healthcare experts and dietitians who focus on gut health, people can get personalized treatment plans that are designed specifically for them. With continuous effort and ongoing help, people with intestinal hyperpermeability can achieve positive results and a better quality of life.