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Editor,—I was interested by the report of Smyth and colleagues on the finding of markers of intestinal inflammation in whole gut lavage in patients with cystic fibrosis.1 As the α1 antitrypsin levels were not elevated when compared to controls, perhaps another hypothesis needs to be considered.
Conceivably the inflammatory markers are not increased within the bowel, but rather, they are not degraded due to the lack of intestinal enzymes. α1 antitrypsin, which is resistant to proteolytic enzyme activity, would not be affected by such a phenomenon and, therefore, would be the same in patients with cystic fibrosis and controls. Perhaps the authors would need to resort to the somewhat dated technique of radio labelled albumin to definitively answer this question.