Saturday, January 06, 2007

Leaky gut in active Crohn's disease due to altered gut permeability

A just published article in the journal Gut reports abnormal claudin protein levels result in patchy loss of barrier function or tight junctions (leaky gut) in Crohn’s disease. This report highlights the growing importance of gut permeability or leaky gut in Crohn's and colitis as well as celiac disease. In the same issue Dr.’s Weber and Turner write a review that is titled “Inflammatory bowel disease: Is it really just another break in the wall?" that “tight junction permeability is the rate limiting step that defines the overall epithelial permeability". They go on to say that "tight junction defects may be an important source of the overall intestinal barrier defects – that is, permeability increases – seen in patients with IBD.” Finally they add that “Zeissig et al provide strong evidence that the tight junction barrier function is altered in IBD". In a separate online article I review the basics of tight juntions, the proteins zonulin, claudin and occludin and how leaky gut occurs.

It is also becoming clear that certain foods trigger and perpetuate the process of altered gut permeability or leaky gut, probably in the context of altered gut microflora or dysbiosis. Genetic susceptibility, altered immune states and co-existing gut injury. It is apparent that a combination of factors may determine whether someone develops celiac disease, Crohn’s disease or non-celiac, non-IBD leaky gut syndrome with a variety of intestinal and non-intestinal symptoms.

If you have a family history of celiac disease or IBD or are known to carry the high-risk genes for celiac disease or gluten intolerance I believe you should be aggressively evaluated especially if you have any symptoms whether they are gastrointestinal or not. The possibility that gluten or undiagnosed IBD causing symptoms should be considered. Those with symptoms who fail to meet diagnostic criteria for celiac disease or IBD should still consider a trial of a gluten free diet.

Those who have been given a diagnosis of IBS or have unexplained or refractory symptoms GI or not, should consider the possibility of role of food and altered gut flora as a cause before giving up the possibilty that they may be able to feel better or avoid medications that are expensive or cause serious side effects. Subscribe to the Food Doc Blog so you receive automatic updates of my reviews of the latest research on the exciting relationship of food, gut and bacteria in health and disease. Forward this post to friends and family via e-mail by simply clicking on the letter icon below.

Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Drago, S et al. Scand J Gastroenterol. 2006; 41(4): 408-419

Inflammatory bowel disease: Is it really just another break in the wall? Weber, CR and Turner, JR. Gut 2007; 56(1): 6-8

Changes in expression and distribution of claudin 2,5, and 8 lead to discontinuous tight junctions and barrier dysfunction in active Crohn’s disease. Zeissig S. et al. Gut 2007; 56(1): 61-72
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Dr. Scot Lewey
the food doc
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