Small intestinal malabsorption in chronic alcoholism determined by ¹³C-D-xylose breath test and microscopic examination of the duodenal mucosa

Abstract

Objective. Diarrhea, weight loss and osteoporosis are prominent symptoms and clinical signs of alcoholism. One of several possible factors causing this clinical picture is small intestinal damage leading to malabsorption. The aim of this study was to prospectively evaluate small intestinal absorption in alcoholics using the ¹³C-D-xylose breath test, and to relate the breath test results to morphological findings of the duodenal mucosa. Material and methods. Sixteen alcoholics without liver failure or serious illness and presenting symptoms of dyspepsia, nausea or diarrhea were included. The ¹³C-D-xylose breath test was performed in 14 of the included subjects. The breath tests of the alcoholics were compared to those of untreated coeliac patients and healthy subjects. Duodenal biopsy specimens were taken for assessment of epithelial morphology in 14 of the included subjects, using light- and electron microscopic techniques. Results. Alcoholics had significantly reduced absorption of ¹³C-D-xylose compared to healthy subjects. The time curve of ¹³C-D-xylose absorption in the group of alcoholics was similar in appearance to that of untreated coeliac patients. Alcoholic patients had few light microscopic changes, but electron microscopic examination exposed morphological pathology in the majority of the patients, with a reduced surface area of microvilli as the main finding. Conclusions. Alcoholics have a pathological ¹³C-D-xylose breath test with a time curve similar to that of untreated coeliac patients. This implies a condition of malabsorption. The morphological pathology found included a reduced absorptive area due to pathology of microvilli. These findings may explain our breath test results.

Key Words::

• Alcoholism
• ¹³C-xylose breath test
• malabsorption
• morphology
• small intestine

Acknowledgement

H. B. H. is supported by a grant from the Eastern Norway Regional Health Authority. V. S. is a shareholder and manager of a commercial laboratory analyzing breath tests (Norske Pusteproever AS).