Active and Passive Sugar Absorption in Pancreatic Insufficiency

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Abstract
Urinary excretion of lactulose, mannitol, and 3-O-methylglucose, following oral administration (5 g, 5 g, and 2 g, respectively, in 100 ml H2O; 80 ml/m2), has been measured in subjects with cystic fibrosis (CF) (22), Shwachman syndrome (3), chronic pancreatitis (3), and normal controls (46). Mean lactulose excretion was increased 10-fold in CF (p < 0.001), and two-fold in other disorders associated with pancreatic insufficiency (PI) (p < 0.05). Mean mannitol excretion was 1.6 times greater in CF (p < 0.001), compared with controls, but was reduced in other forms of PI (p < 0.03). The mean lactulose/mannitol excretion ratio was increased in all types of PI (p < 0.001). There were no significant differences in 3-O-methylglucose excretion. This study confirms the large increase in lactulose absorption recently reported in CF and also demonstrates increased absorption of mannitol; these changes are different than those in other forms of PI. This study provides further evidence for a specific abnormality of the mucosal barrier to the absorption of passively absorbed, water soluble molecules in CF.