A influência do Saccharomyces boulardii na permeabilidade intestinal de pacientes com doença de Crohn em fase de remissão

Abstract

Crohns disease (CD) is a condition characterized by a tendency chronic and relapsing inflammation, within the gastrointestinal tract. One of the primary goals of treatment is to maintain remission. Among etiologic factors, increased gut permeability allows presenting antigens to the mucosa immune system, trigging or maintaining inflammation. It has been supposed that probiotcs can induce benefic effect in intestinalmicroflora, and get better barrier function of intestinal mucosa. The aim of the study was to evaluate S. boulardii influence in gut permeability of remission CD patients. In double-blinded, placebo-controlled, S. boulardii were administered for three months to 31 patients. The maintenance treatment was not interrupted. The intestinal permeabilitywas done immediately before the treatment begin, at the end of the first month and at the end of the third month. Eleven health controls subjects was also submit to the test. In this group, median percentage of lactulose excretion was 2,56%, mannitol excretion was 23% and permeability ratio was 0,1. After comparing with CD pacients results, the p value was 0,002 for lactulose, 0,58 for mannitol and 0,016 for permeability ratio. Thecomparison between medias differences of lactulose excretion, mannitol excretion and permeability ratio, was done in to intend evaluate S. boulardii influence in gut permeability. In Placebo group, the initial lactulose excretion was 16,3% and at the end of the third month was 20,13% (p= 0,16); the mannitol excretion was 21,14% in the beginning and 21,93% at the of following period (p= 0,39) and the permeability ratiowas 0,79 initially and 0,935 at the end (= 0,164). In the S. boulardii group, the results was 19,88% and 16,04% for lactulose (p= 0,017), 21,42% and 20,82% for mannitol (p=0,49) and 0,95 and 0,775 for permeability ratio (p= 0,011). When CDAI score was compared with permeability test, r2 values was less than 0,1. Only one patient was relapsed and belongs to Placebo group (p> 0,05). Our results suggest that remission CDpatients have important intestinal mucosa integrity alterations.; the S. boulardii got better intestinal permeability, but did not normalized it; the behavior of intestinal permeability test was not associated with CDAI score and the use of S. boulardii did not influence the disease clinical behavior during the following period.