Fecal zonulin as a biomarker of increased intestinal permeability in patients with irritable bowel syndrome (narrative review and pilot study results)

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Current data demonstrate that intestinal barrier dysfunction is one of the key mechanisms in irritable bowel syndrome (IBS) development. Hence, assessment of intestinal permeability seems to be especially relevant for clinical practice. However, existing morphological methods are invasive and expensive, and most of the available functional tests are difficult to carry out in routine practice, require much time, and have low validity due to undefined optimal values. The need for dynamic control also limits the use of all these methods. Therefore, the search for non-invasive, highly informative biomarkers of intestinal permeability is essential. Zonulin is an endogenous analog of Vibrio cholerae toxin that can reversibly open tight junctions is being actively studied as a potential candidate. Fecal zonulin detection should be considered as a promising diagnostic test since it reflects the secretion of protein directly from the site of epithelial damage. Our pilot study demonstrated increased fecal zonulin levels in 55 patients with IBS, allowing us to confirm the possibility of using this method for the non-invasive assessment of intestinal permeability in these patients.

Keywords:

intestinal barrier

intestinal permeability

tight junction proteins

zonulin

irritable bowel syndrome

Authors:

Livzan M.A.

Omsk State Medical University

ORCID: 0000-0002-6581-7017

Gaus O.V.

Omsk State Medical University

Received:

10.03.2021

Accepted:

30.06.2021

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