Rheumatology Advance Access originally published online on June 7, 2008
Rheumatology 2008 47(8):1223-1227; doi:10.1093/rheumatology/ken140
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Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome
1Pain Management Centre, University Hospital Wuerzburg, Wuerzburg and 2Department for Gastroenterology, Hepatology and Endocrinology, Charité Universitätsmedizin, Berlin, Germany.
Correspondence to: A. Goebel, The Walton Centre NHS Trust, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK. E-mail: andreasgoebel{at}rocketmail.com
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Abstract |
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Objectives. The pain intensity of patients with FM has recently been reported to be correlated with the degree of small intestinal bacterial overgrowth (SIBO). SIBO is often associated with an increased intestinal permeability (IP). Increased IP, if shown in FM, may have pathogenetic relevance because it leads to the exposure of immune cells to luminal antigens and consequent immune modulation. It is currently unknown whether IP is altered in FM. We therefore examined the IP in a group of patients with primary FM and in two control groups, healthy volunteers and patients with an unrelated chronic pain syndrome, complex regional pain syndrome (CRPS). We hypothesized that patients with FM, but not volunteers or those patients with CRPS, would have altered IP.
Methods. Both gastroduodenal and small IP were assessed using an established three-sugar test, where urinary disaccharide excretion reflecting intestinal uptake was measured using HPLC.
Results. Forty patients with primary FM, 57 age- and sex-matched volunteers and 17 patients with CRPS were enrolled in this study. In the FM group, 13 patients had raised gastroduodenal permeability and 15 patients had raised small intestinal permeability, but only one volunteer had increased gastroduodenal permeability (P < 0.0001, chi-square test for the three groups). The IP values were significantly increased in the patient groups (P < 0.0003 for all comparisons, one-way analysis of variance).
Conclusions. The IPs in primary FM and, unexpectedly, CRPS are increased. This study should stimulate further research to determine the implication of altered IP in the disease pathophysiology of FM and CRPS.
KEY WORDS: Fibromyalgia, Complex regional pain syndrome, Intestinal permeability, Chronic pain
Submitted 14 October 2007;
revised version accepted 14 March 2008.
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