Cellobiose/mannitol sugar permeability test in children in relation to jejunal morphometry.

The ability of the sugar permeability test to detect minor degrees of mucosal damage is uncertain, particularly in children. This paper reviews experience with the cellobiose/mannitol test at a referral centre of paediatric gastroenterology, relating the results of intestinal permeability to the jejunal morphometry. Two hundred patients underwent the cellobiose/mannitol test at the same time as jejunal biopsy; morphometric analysis of the biopsy specimens was performed by a computerized image analysis system. Increased sugar permeability was revealed in 89%, 80%, 67% and 18% of subjects with subtotal villous atrophy, severe partial villous atrophy, mild partial villous atrophy and normal histological picture, respectively. Nevertheless, once the patients with the most severe changes in their mucosal architecture had been excluded, there was no statistically significant correlation between cellobiose/mannitol ratio and villous and crypt length, villous/crypt ratio and intraepithelial lymphocytes density. The cellobiose/mannitol test is a good indicator of severe mucosal damage; it does not discriminate subjects with minor degrees of mucosal abnormalities, but may give useful indications on the functional state of the jejunal mucosa.