Portal de Periódicos da CAPES

Increased Intestinal Permeability in Active Pulmonary Sarcoidosis

1992; American Thoracic Society; Volume: 145; Issue: 6 Linguagem: Inglês

10.1164/ajrccm/145.6.1440

2376-3752

B. Wallaert, Jean‐Frédéric Colombel, Antoine Adenis, X. Marchandise, Roger Hällgren, Anne Janin, André‐Bernard Tonnel,

Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis

Altered permeability of the gut is a well-described feature in Crohn's disease. Because of pathologic similarities between Crohn's disease and sarcoidosis, we initiated this study to evaluate the permeability of the gut mucosal lining in patients with pulmonary sarcoidosis. A group of 18 patients with biopsy-proven pulmonary sarcoidosis (active n = 8, inactive n = 10) were included in the study. Control groups included 22 patients with Crohn's disease (active n = 12, inactive n = 10), nine untreated patients with recent pulmonary tuberculosis, six patients with coal worker's pneumoconiosis (CWP), eight patients with idiopathic pulmonary fibrosis (IPF), and 16 healthy subjects. All were nonsmokers. The 24-h urinary excretion of 100 µaCi 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) was used to test the intestinal permeability (IP). As previously demonstrated, patients with active Crohn's disease demonstrated a dramatic increase in IP (7.7 ± 1.4%) that was clearly reduced in inactive CD (2.34 ± 0.54%). Patients with active pulmonary sarcoidosis exhibited a marked increased IP to 51Cr-EDTA (4 ± 0.54%), which was not found in patients with inactive sarcoidosis (1.6 ± 0.17%). IP was normal in patients with pulmonary tuberculosis (1.03 ± 0.25%), CWP (2.1 ± 0.54%), and IPF (1.9 ± 0.33%) and did not differ from the control group (1.76 ± 0.23%). In addition, in 6 patients with active pulmonary sarcoidosis, the concentrations of albumin and hyaluronan were measured in jejunal perfusion fluid and compared with those obtained from 10 patients with active Crohn's disease and 16 control subjects. The albumin concentrations were similar between patients and control subjects. In contrast, increased concentrations of hyaluronan, similar to those observed in Crohn's disease, were observed in sarcoidosis, suggesting an enhanced leakage and/or synthesis from the interstitial or lymph fluid. In addition, light and electron microscope studies of intestinal biopsies in these six patients revealed an intercellular lesion with moderate edema and accumulation of T lymphocytes. Taken together, our results suggest that a subclinical inflammation of the gut is present in active sarcoidosis, resulting in an abnormal intestinal barrier that may contribute to the pathogenesis of sarcoidosis.