The Effect of Ingested Lactulose on Absorption of L-Rhamnose, D-Xylose, and 3-O-Methyl-D-Glucose in Subjects with Ileostomies

Jenkins AP, Menzies IS, Nukajam WS, Creamer B. The effect of ingested lactulose on absorption of L-rhamnose, D-xylose. and 3-O-methyl-D-glucose in subjects with ileostomies. Scand J Gastroenterol 1994;29:820-825. Background: We have previously shown that small oral doses of poorly absorbed solute can significantly reduce absorption of test sugars in normal volunteers. To confirm these results and investigate the underlying mechanism, the effects of lactulose on absorption of three test sugars in subjects with ileostomies were studied. Methods: Ten fasted subjects with ileostomies ingested an isosmolar test solution containing 2.5g 3-O-methyl-D-glucose, 5.0g D-xylose, 1.0g L-rhamnose, and 50μCi 51Cr-labelied ethylenediaminetetraacetic acid together with a blue dye transit marker. Urine was collected for time periods of 0-5 h and 5-24 h, to measure excretion of absorbed sugars, and ileostomy effluent was saved from 0-5 h and from 5 h until blue dye transit marker was no longer present, to measure small-bowel output of unabsorbed sugars. After 1 week the test was repeated, including 5 g lactulose in the test solution. Results: Inclusion of lactulose in the test solution significantly reduced the 5 h and 24 h urine excretion of l -rhamnose and D-xylose but not that of 3-O-methyl-D-glucose and increased 0- to 5-h and total ileostomy output of L-rhamnose and D-xylose but not of 3-O-methyl-D-glucose. The presence of lactulose also reduced the time for first appearance of the blue dye transit marker in the effluent and increased effluent volume together with output of electrolyte. Conclusion: Poorly absorbed solute reduces intestinal absorption by retention of fluid and electrolyte, with subsequent intraluminal dilution and acceleration of transit.