Non-invasive measurement of intestinal barrier function in environmental enteropathy using transcutaneous fluorescence sensing
File(s)
Author(s)
Type
Journal Article
Abstract
Background
Undernutrition represents a critical global health concern and is associated with a
multifaceted breakdown in gut function – termed environmental enteropathy (EE) –
which leads to increased intestinal permeability, inflammation and nutrient
malabsorption. Current clinical approaches to assess intestinal permeability are
costly, invasive, unreliable and/or difficult to perform in certain populations.
Objectives
We used transcutaneous fluorescence spectroscopy (TFS) – a novel method for
non-invasive assessment of gut function – to investigate intestinal barrier function
in EE.
Design
Volunteers were recruited in a Zambian community where EE is prevalent, and in
the UK to undergo TFS measurements in a cross-sectional study. Data were
compared between groups and were correlated with the lactulose:rhamnose (LR)
test.
Results
TFS demonstrated significant differences in intestinal barrier function between UK
and Zambian volunteers. Both peak fluorescence intensity (p=0.003) and area
under fluorescence curves (p=0.02) were higher in Zambian than UK participants,
suggesting increased permeation of TFS contrast agent. No differences were
observed in time taken to reach peak, indicating no differences in factors affecting
uptake rate (e.g. gastric emptying). Finally, fluorescence kinetics and regression
analysis revealed strong correlations between TFS data and urinary recoveries of
lactulose and rhamnose (Spearman’s r ≥ 0.78; p < 0.002).
Conclusions
TFS reveals population differences in permeability. It also allows simultaneous
assessment of multiple elements of gut function (intestinal barrier integrity and
gastric emptying) using a rapid, sample-free methodology. Combined with
correlation to the LR test, this implies potential to advance studies of gut health and
to improve clinical monitoring.
Undernutrition represents a critical global health concern and is associated with a
multifaceted breakdown in gut function – termed environmental enteropathy (EE) –
which leads to increased intestinal permeability, inflammation and nutrient
malabsorption. Current clinical approaches to assess intestinal permeability are
costly, invasive, unreliable and/or difficult to perform in certain populations.
Objectives
We used transcutaneous fluorescence spectroscopy (TFS) – a novel method for
non-invasive assessment of gut function – to investigate intestinal barrier function
in EE.
Design
Volunteers were recruited in a Zambian community where EE is prevalent, and in
the UK to undergo TFS measurements in a cross-sectional study. Data were
compared between groups and were correlated with the lactulose:rhamnose (LR)
test.
Results
TFS demonstrated significant differences in intestinal barrier function between UK
and Zambian volunteers. Both peak fluorescence intensity (p=0.003) and area
under fluorescence curves (p=0.02) were higher in Zambian than UK participants,
suggesting increased permeation of TFS contrast agent. No differences were
observed in time taken to reach peak, indicating no differences in factors affecting
uptake rate (e.g. gastric emptying). Finally, fluorescence kinetics and regression
analysis revealed strong correlations between TFS data and urinary recoveries of
lactulose and rhamnose (Spearman’s r ≥ 0.78; p < 0.002).
Conclusions
TFS reveals population differences in permeability. It also allows simultaneous
assessment of multiple elements of gut function (intestinal barrier integrity and
gastric emptying) using a rapid, sample-free methodology. Combined with
correlation to the LR test, this implies potential to advance studies of gut health and
to improve clinical monitoring.
Date Issued
2026-03-01
Date Acceptance
2026-02-21
Citation
Gut Science, 2026, 1 (1)
ISSN
2978-1833
Publisher
BMJ Publishing Group
Journal / Book Title
Gut Science
Volume
1
Issue
1
Copyright Statement
© Author(s) (or their employer(s)) 2026. Re- use permitted under CC BY. Published by BMJ Group. For numbered affiliations see end of article.
License URL
Identifier
10.1136/gutsci-2025-000011
Publication Status
Published
Article Number
000011
Date Publish Online
2026-03-01