New Test for “Leaky Gut” Proposed

New Test for “Leaky Gut” Proposed

Douglas K. Rex, MD, MASGE, reviewing Khoshbin K, et al. Gastroenterology 2021 Apr 15.

We often hear about the idea of “leaky gut,” which refers to intestinal permeability resulting from medications or certain diets, and that this condition may result in clinically important symptoms. When the issue of leaky gut arises in the clinic, we do not have a reliable test for it.

This study comes from a U.S. center of motility excellence. It evaluated absorption of several types of sugar and found that baseline urinary excretion is high enough (because of dietary contamination) to make excretion measurements useless as assessments of intestinal permeability. However, 13Carbon (13C)-mannitol excretion after the ingestion of standardized meals was found to be a reliable measure of small intestinal permeability, and results were independent of fiber intake, age, sex, or body mass index. 

A 13C-mannitol test of intestinal permeability is currently in development.

Douglas K. Rex, MD, FASGE


There are a lot of unanswered questions about leaky gut syndrome. Having a reliable measure of intestinal permeability is an important step in answering these questions.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Khoshbin K, Khanna L, Maselli D, et al. Development and validation of test for “leaky gut” small intestinal and colonic permeability using sugars in healthy adults. Gastroenterology 2021 Apr 15. (Epub ahead of print) (

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