Colonic Mucosal Immune Activity in Irritable Bowel Syndrome: Comparison with Healthy Controls and Patients with Ulcerative Colitis

Ahn, Ji Yong; Lee, Kyung Hun; Choi, Chang Hwan; Kim, Ju Wan; Lee, Hyun Woong; Kim, Jeong Wook; Kim, Mi Kyung; Kwon, Gui Young; Han, Seungbong; Kim, Seong Eun; Kim, Sung Min; Chang, Sae Kyung

doi:10.1007/s10620-013-2930-4

Cited by 51 publications

(60 citation statements)

References 44 publications

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“…The most consistent finding in this area is enhanced colonic infiltration of mucosal mast cells (19) , cells important for pathogen defence and that may directly influence enteric sensory nerves (20) . Indeed, higher colorectal mucosal mast cell infiltration has been reported in IBS-D compared with healthy controls, levels that were comparable with samples of patients with ulcerative colitis in remission (21) . It is proposed that increased intestinal permeability (i.e.…”

Section: Pathogenesis Of Irritable Bowel Syndromesupporting

confidence: 62%

Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet

Staudacher

Whelan

2016

Proc. Nutr. Soc.

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Irritable bowel syndrome (IBS) is a functional bowel disorder characterised by abdominal pain or discomfort with disordered defecation. This review describes the role of the gastrointestinal (GI) microbiota in the pathogenesis of IBS and how dietary strategies to manage symptoms impact on the microbial community. Evidence suggests a dysbiosis of the luminal and mucosal colonic microbiota in IBS, frequently characterised by a reduction in species of Bifidobacteria which has been associated with worse symptom profile. Probiotic supplementation trials suggest intentional modulation of the GI microbiota may be effective in treating IBS. A smaller number of prebiotic supplementation studies have also demonstrated effectiveness in IBS whilst increasing Bifidobacteria. In contrast, a novel method of managing IBS symptoms is the restriction of short-chain fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet). Studies consistently demonstrate clinical effectiveness of the low FODMAP diet in patients with IBS. However, one unintentional consequence of this dietary intervention is its impact on the microbiota. This leads to an interesting paradox; namely, increasing luminal Bifidobacteria through probiotic supplementation is associated with a reduction in IBS symptoms while in direct conflict to this, the low FODMAP diet has clinical efficacy but markedly reduces luminal Bifidobacteria concentration. Given the multifactorial aetiology of IBS, the heterogeneity of symptoms and the complex and diverse nature of the microbiome, it is probable that both interventions are effective in patient subgroups. However combination treatment has never been explored and as such, presents an exciting opportunity for optimising clinical management, whilst preventing potentially deleterious effects on the GI microbiota. Irritable bowel syndrome: Prebiotic: Probiotic: FODMAP Irritable bowel syndromeFunctional bowel disorders are characterised by chronic lower gastrointestinal (GI) symptoms in the absence of alarm features that suggest presence of other disease (1,2) . The criteria for irritable bowel syndrome (IBS), one of the most common functional bowel disorders, requires the presence of abdominal pain or discomfort together with an alteration in stool output (1) . IBS is a common condition worldwide, contributes up to 30 % of gastroenterology consultations in the UK (3) , affects more females than males and is more prevalent in those under 40 years of age (4) . A pooled prevalence of IBS in 14 % of females and 9 % of males has been reported in a large systematic review and meta-analysis of fifty-five studies conducted across America, Asia, Europe and Africa (4) .Four different IBS subtypes exist based on predominant stool form, and each may differ in their aetiology.

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Section: Pathogenesis Of Irritable Bowel Syndromesupporting

confidence: 62%

Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet

Staudacher

Whelan

2016

Proc. Nutr. Soc.

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“…68 As a low grade inflammation condition, IBS patients had significantly higher colorectal mucosal immune cell counts than healthy controls, including MCs, intraepithelial lymphocytes, and lamina propria lymphocytes. 69 Besides, increased MC and lymphocyte numbers have also been detected in the ileum and duodenum. 12 MCs release of inflammatory mediators contribute to the recruitment of other immune cells, for instance, interleukin-6, interleukin-8 and TNF-α recruit neutrophils, while IL-3, IL-5, IL-13, and granulocytemacrophage colony-stimulating factor (GM-CSF) recruit eosinophils and basophils, chemokines such as monocyte chemotactic protein 1, and macrophage inflammatory protein 1α and 1β also play important roles.…”

Section: Mast Cells In Gut Immunomodulation and Inflammationmentioning

confidence: 99%

Mast Cells and Irritable Bowel Syndrome: From the Bench to the Bedside

Zhang

Song

Hou

2016

J Neurogastroenterol Motil

108

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Irritable bowel syndrome (IBS) is traditionally defined as a functional disorder since it lacks demonstrable pathological abnormalities. However, in recent years, low grade inflammatory infiltration, often rich in mast cells, in both the small and large bowel, has been observed in some patients with IBS. The close association of mast cells with major intestinal functions, such as epithelial secretion and permeability, neuroimmune interactions, visceral sensation, and peristalsis, makes researchers and gastroenterologists to focus attention on the key roles of mast cells in the pathogenesis of IBS. Numerous studies have been carried out to identify the mechanisms in the development, infiltration, activation, and degranulation of intestinal mast cells, as well as the actions of mast cells in the processes of mucosal barrier disruption, mucosal immune dysregulation, visceral hypersensitivity, dysmotility, and local and central stress in IBS. Moreover, therapies targeting mast cells, such as mast cell stabilizers (cromoglycate and ketotifen) and antagonists of histamine and serotonin receptors, have been tried in IBS patients, and have partially exhibited considerable efficacy. This review focuses on recent advances in the role of mast cells in IBS, with particular emphasis on bridging experimental data with clinical therapeutics for IBS patients.

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“…In the paper by Choi et al [3] published in this issue of Digestive Diseases and Sciences, the authors analyzed intestinal MC density in: (a) diverse patient cohorts, including diarrhea predominant-IBS (D-IBS), ulcerative colitis (UC) in remission, mild UC, and in healthy controls; (b) random colonic biopsies; (c) different colonic segments; and (d) mucosal MC and lamina propria/intra-epithelial T lymphocytes. The results are important because MC number was significantly increased in 97.6 % of D-IBS patients, intra-epithelial lymphocytes (IEL) were increased in 92.8 %, and lamina propria lymphocytes (LPL) were increased in 81.9 %.…”

Section: Background and Significance Of Issues And Controversiesmentioning

confidence: 99%

“…All publications to date, including the one by Choi et al [3], did not report MC activation, which, according to some, is more important than actual numbers [4].…”

Section: Background and Significance Of Issues And Controversiesmentioning

confidence: 99%

Mast Cells in Irritable Bowel Syndrome and Ulcerative Colitis: Function Not Numbers Is What Makes All the Difference

Theoharides

2014

Dig Dis Sci

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Colonic Mucosal Immune Activity in Irritable Bowel Syndrome: Comparison with Healthy Controls and Patients with Ulcerative Colitis

Abstract: Patients with D-IBS had significantly higher colonic mucosal immune-cell counts than healthy controls but had similar counts to patients with UC in remission. The symptoms in both conditions may originate from low-grade inflammation in the colonic mucosa.

Cited by 51 publications

References 44 publications

Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet

Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet

Mast Cells and Irritable Bowel Syndrome: From the Bench to the Bedside

Mast Cells in Irritable Bowel Syndrome and Ulcerative Colitis: Function Not Numbers Is What Makes All the Difference

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