Combination of Allergic Factors Can Worsen Diarrheic Irritable Bowel Syndrome: Role of Barrier Defects and Mast Cells

Abstract

In IBS patients, the presence of an allergic background correlates with a more severe disease and diarrhea predominance, possibly by enhancing mucosal MC activation and paracellular permeability.

Immune Activation in Irritable Bowel Syndrome: Can Neuroimmune Interactions Explain Symptoms?

“…However, reports of variation in the absolute number of mast cells in the intestine are confl icting, as a similar number of studies indicate mast cell numbers are increased or unchanged in IBS patients ( Table 2 ) ( 44,48 -67 ). In those studies that observed increased mast cell numbers, correlations with symptoms are also mixed ( Table 1 ) ( 37,41,50,52,53,55,59,63 ). Despite this contention, the absolute number of mast cells may not be the defi ning characteristic of their involvement in IBS.…”

“…Single-nucleotide polymorphisms in CDH1 , which encodes the tight junction protein E-cadherin, are associated with increased risk of post-infectious IBS ( 40 ). Detailed molecular studies of the epithelial barrier indicate the expression and subcellular distribution of tight junction proteins are substantially altered in IBS patients ( 41 -44 ), and impaired intestinal permeability has been shown to correlate with pain / discomfort and / or bowel habit ( Table 1 ) ( 34,37,41,43 ). However, impaired barrier defenses are unlikely to directly cause pain, but instead ease access of luminal contents to the GI wall, promoting infl ammatory responses and modulating sensory-motor function.…”

“…Th e primary role of B cells is to produce antibodies (Ig) directed against antigen, and IgG-positive B cells are increased in the blood of IBS patients relative to healthy subjects ( 68 ). Increased blood IgE and IgG concentrations are classically associated with allergy and are typically unaltered in IBS at baseline; however, in response to allergen serum IgE and IgG levels increase in IBS patients above that observed in health ( 37,70,71 ). Interestingly, increased levels of autoantibodies against neuronal channels have been observed in IBS patients; however, the clinical implications of this are yet to be determined ( 105,106 ).…”

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

“…Numerous studies have focused on the relationship between MCs infiltration and the clinical aspects of IBS. 17,23,24 The severity of IBS significantly correlated with colonic MCs counts and spontaneous release of tryptase. 24 The MCs in close proximity to nerves significantly correlated with the severity and frequency of abdominal pain/discomfort.…”

Potential utility of double-balloon enteroscopy for the diagnosis and evaluation of gastrointestinally mediated allergy

“…The diagnosis of gastrointestinally mediated allergy was therefore confirmed and the patient was treated successfully with budesonide, mast cell stabilizers, and antihistamines. It has been reported that allergic and immuno-inflammatory disorders are increasing along with irritable bowel syndrome [4]. In this report we have highlighted several functions of this new double-balloon enteroscope (the close focus and zoom functions and the 3.2-mm forceps channel) that can be used along with endoscopic lavage to ensure that such diseases are adequately recognized in the near future.…”