The "Leaky Gut" Hypothesis

March 9, 2015 Uma Pisharody, MD, FAAP

Have you heard of the term “leaky gut”? It’s used to describe a (scientifically unproven) theory, which proposes that the lining of the gastrointestinal (GI) tract could be abnormally permeable to dietary and other environmental substances, which then “leak” into the blood stream to trigger inflammation. Sometimes, the “leaky gut” theory is put forth as the cause of a variety of poorly understood diseases, ranging from autism to autoimmune disorders such as multiple sclerosis.

As a gastroenterologist, trained with the knowledge of how the internal mechanics of the gut lining are designed to make it an effective barrier, I have always found it hard to accept this hypothesis. I wanted to share the findings of a recent publication showing that in a group of children known to have food allergies and gut inflammation, their GI tract was no more “leaky”, compared to the intestinal tracts of healthy children.

This study, published in the February 2015 issue of the Journal of Pediatric Gastroenterology and Nutrition, analyzed over 80 children, over two-thirds of whom were patients seen by pediatric gastroenterologists due to various symptoms and GI problems (the remaining kids were healthy children).  About a third of the patients were diagnosed with Eosinophilic Esophagitis, an allergic disease which causes inflammation in the lining of the esophagus (food pipe). Approximately 25% of the children had GERD (gastroesophageal reflux disease), a condition that also causes inflammation of the lining of the esophagus, but from acid reflux.

Intestinal permeability was measured for all of the children. No significant difference was seen between children with or without symptoms, or those with or without disease. 

Although the study size was small, it served to show that the integrity of the gut lining is not necessarily compromised even when there is inflammation within. Although increased gut permeability can be seen in some diseases like celiac and Crohn’s disease, even in these conditions, as explained by the authors of this research study, not much evidence exists about whether this “leakiness” is a cause or effect.

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