Therefore, intact sucrose molecules serve as a marker for gastric permeability 6. The disaccharide sucrose is, after passing the first part of the digestive tract, cleaved into glucose and fructose in the jejunum. Hereby, mannitol uses a transcellular pathway, whereas lactulose and sucrose are transported paracellularly through intercellular junctions between enterocytes. The current gold standard is a combination of the carbohydrates mannitol, lactulose, and sucrose 2, 3, 4, 5. Differences in cellular pathways of these passively absorbed sugars, make the determination of deficiencies of mucosal barriers, and absorbance efficiency in the gut feasible. Intestinal and upper digestive tract permeability is functionally analyzed by orally administering chemically inert, not metabolized reference substances to patients and by tracing their distribution and finally renal excretion. Therefore analysis of an increased intestinal permeability is inevitable for preventing profound infections 1. Besides common disease indications like altered liver histology, alterations in hepatic venous pressure or blood parameters, increased intestinal and gastric permeability are hallmarks of advanced liver disease resulting in severe septic complications. Liver cirrhosis is a major global health burden with a continuously rising incidence. Overall, this article presents a fast and robust method for simultaneous quantification of different sugars down to low micro-molar concentrations for research studies and can be further extended for clinical studies with automation of the quantification process. Collected urine samples were diluted in buffer and one- and two-dimensional proton spectra were recorded in order to reveal carbohydrate concentrations in individual urine samples containing mannitol, sucrose and/or lactulose. Here we used Nuclear Magnetic Resonance (NMR) spectroscopy with a simple and fast protocol, without any additional sample extraction steps, for straight-forward simultaneous quantification of sugars in urine in order to detect increased intestinal and gastric permeability. However, reliable detection and quantification of these sugars in a complex biological fluid still remains challenging due to interfering substances. Hereby, elevated lactulose levels indicate intestinal permeability, whereas increased sucrose levels reveal gastric permeability. The current gold standard for diagnosis of aberrant gut permeability due to disease is the triple-sugar test, where carbohydrates are orally administered and urinary excretion is measured. Increased intestinal or gastric permeability is one of the major hallmarks of liver cirrhosis.
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