Increased Chromogranin A Cell Density in the Large Intestine of Patients with Irritable Bowel Syndrome after Receiving Dietary Guidance

Mazzawi, Tarek; Gundersen, Doris; Hausken, Trygve

doi:10.1155/2015/823897

Cited by 24 publications

(28 citation statements)

References 53 publications

(52 reference statements)

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“…28,30 The changes in the different enteroendocrine cell densities identified herein may have contributed to the previously reported improvement in IBS symptoms and the QOL of these IBS patients. 12 The results of the current study shed some light on the involvement of the enteroendocrine cells in the pathophysiology of IBS.…”

Section: Resultssupporting

confidence: 53%

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Mazzawi

2017

Exp Biol Med (Maywood)

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Several contributing factors to the symptomology of irritable bowel syndrome (IBS) have been identified, such as abnormal densities of enteroendocrine cells and diet; however, the interactions between these factors have not been studied yet. The current study aims at exploring the dynamic changes between these two factors by studying the effect of using low fermentable oligo-, di-, monosaccharides and polyol (FODMAP) diet (known to improve IBS symptoms) through dietary guidance on the enteroendocrine cell densities in the duodenum. The findings showed that the densities of different enteroendocrine cells in the duodenum were abnormal before the patients received dietary guidance and tend to change/normalize after receiving guidance, which may have contributed in improving the symptoms of IBS. These findings highlight the importance of enteroendocrine cells in IBS pathophysiology and the mechanism behind the positive effect of low FODMAP dietary guidance in improving IBS symptoms and its usage as first step in the line of IBS management. AbstractThe densities of enteroendocrine cells are abnormal in patients with irritable bowel syndrome (IBS); however, they tend to change toward normal levels in stomach, ileum, and colon following dietary guidance. The aim was to identify the types of duodenal enteroendocrine cells affected after receiving dietary guidance in the same group of patients with IBS. Fourteen patients with IBS and 14 control subjects were included. The patients received three sessions of dietary guidance. Both groups underwent gastroscopies at baseline, and again for the patients after 3-9 months (median, four months) from receiving dietary guidance. Tissue biopsies were collected from the descending part of the duodenum and were immunostained for all the types of enteroendocrine cells and were then quantified by using computerized image analysis. Using the Kruskal-Wallis non-parametric test with Dunn's test as a post-test, the results showed a significant difference in the secretin cell densities between control subjects and patients with IBS prior to and following dietary guidance (P ¼ 0.0001 and 0.011, respectively). The corresponding P values for cholecystokinin (CCK) cell densities were 0.03 and 0.42, respectively; gastric inhibitory peptide (GIP) cell densities were 0.06 and 0.43, respectively; serotonin cell densities were <0.0001 and 0.002, respectively; and for somatostatin cell densities were <0.0001 and 0.052, respectively. The Paired t-test showed a significant difference only in the serotonin (P ¼ 0.03) and somatostatin (P < 0.0001) cell densities between IBS patients prior to and following dietary guidance. The changes in the cell densities of secretin, CCK, and GIP were not significant between IBS patients prior to and following dietary guidance. In conclusion, the densities of several duodenal enteroendocrine cells in IBS patients changed toward the values measured in control subjects following dietary guidance. The changes in serotonin and somatostatin cell densities may have contrib...

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Section: Resultssupporting

confidence: 53%

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Mazzawi

2017

Exp Biol Med (Maywood)

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“…A previous study found that changing the dietary intake by the provision of individualized dietary guidance altered the large intestinal total endocrine cells as detected by a general marker for endocrine cells (chromogranin A). 36 The observed change in chromogranin A cell density after receiving dietary guidance was toward the normal values of controls. However, which endocrine cell type was affected is not clear.…”

Section: Introductionmentioning

confidence: 81%

“…It is worth mentioning that neither age nor gender affects the densities of the endocrine cells in the large intestine. 36 , 43 …”

Section: Discussionmentioning

confidence: 99%

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Dietary guidance normalizes large intestinal endocrine cell densities in patients with irritable bowel syndrome

Mazzawi

Hausken

Gundersen³

2015

Eur J Clin Nutr

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Background/Objectives:To determine the large intestinal endocrine cell types affected following dietary guidance in patients with irritable bowel syndrome (IBS).Subjects/Methods:The study included 13 IBS patients and 13 control subjects. The patients received three sessions of individualized dietary guidance. Both the control subjects and the patients were scheduled for colonoscopies at baseline and again for the patients at 3–9 months after dietary guidance. Biopsy samples were taken from the colon and rectum and were immunostained for all types of large intestinal endocrine cells. The endocrine cells were quantified using computerized image analysis.Results:The daily total consumption (mean±s.e.m. values) of fruits and vegetables rich in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) decreased significantly from 16.2±5.3 g before receiving dietary guidance to 9.2±3.2 g after receiving dietary guidance (P=0.02). In the total colon, the densities of serotonin cells were 46.8±8.9, 10.5±2.1 and 22.6±3.2 cells/mm2 in control subjects and in IBS patients before and after receiving dietary guidance, respectively (P=0.007); the corresponding densities of peptide YY cells were 11.6±1.8, 10.8±1.7 and 16.8±2.1 cells/mm2, respectively (P=0.06). The cell densities for both serotonin and peptide YY did not change significantly in the rectum. The densities of somatostatin cells in the rectum were 13.5±3.0, 13.2±3.0, and 22.3±3.2 cells/mm2 for control subjects and for IBS patients before and after receiving dietary guidance, respectively (P=0.01).Conclusions:The densities of the large intestinal endocrine cells tend to normalize following dietary guidance that may have contributed to the improvement of the patients with IBS symptoms.

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“…The seminal traits of abnormalities in IBS are clinical (1,2), histological (3)(4)(5), histoimmunological (6)(7)(8)(9)(10)(11) and neurophysiologic (12,13). Added to these are new observations related to the enteric microbiome (14) and its relationship to IBS; this gutbrain relationship between enteric microbiome and central nervous system can be visualized by physiologic neuroimaging (15,16).…”

Section: Review Articlementioning

confidence: 99%

Deciphering the pathophysiology of irritable bowel syndrome and functional gastrointestinal disorders—an alternative model for pathogenesis: cytokine controlled transepithelial multi-feedback loop

McCullough

2017

Transl. Gastroenterol. Hepatol.

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A working theoretical model for irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) does not exist, hampered by the lack of any clear cut invention that address all symptom and signs of the disease. Reports of cessation of symptom and signs of both major types of IBS have been published using a non-systemic, topically active agent-high potency polymerized cross-linked sucralfate (HPPCLS). The unique clinical effect of this non-systemic agent restricted to the luminal surface of the gut provides opportunity to elaborate on an alternative working model for the pathogenesis of IBS and FGIDs. While the chemical determinants of HPPCLS and the mucosal lining contribute to the clinical effects, the sequence of events resides in the functional interplay among elements within the mucosa itself.The proposed model assumes that failure of a pre-existing genomic-controlled surveillance of the epithelium localized to the luminal surface triggers primary and secondary immune activation of inflammation intent on restoring epithelial homeostasis. Delayed restoration of homeostasis results in all the symptoms, signs and likely molecular events that characterize IBS and FGIDs. serve as an efficient collection of prominent features of the disease consisting of relevant cohorts of symptom/sign observations that characterize IBS and other functional gastrointestinal disorders (FGIDs) (1). The seminal traits of abnormalities in IBS are clinical (1,2), histological (3-5), histoimmunological (6-11) and neurophysiologic (12,13). Added to these are new observations related to the enteric microbiome (14) and its relationship to IBS; this gutbrain relationship between enteric microbiome and central nervous system can be visualized by physiologic neuroimaging (15,16). Instead of providing a working model, these observations present characteristics of IBS that are short of identifying causative determinants. It is likely that these observations represent the physiologic effects of yet to be determined cause or causes that induce the syndrome. This is true of the other functional GI disorders including non-erosive reflux, functional dyspepsia, and esophageal pain syndrome. Investigations have uncovered many features or traits, with no single one or two observations able to direct investigational efforts toward a definitive identification of the origin of these disorders. An alternative starting point-effective therapeutic interventionAn alternative starting point for any pathogenesis model is an effective therapeutic intervention-an intervention that brings about rapid and complete reversal of disease, that is, complete amelioration of signs and symptoms that define the disorder. This occurred with the discovery of insulin, various classes of antibiotics and targeted immuno-therapies for psoriasis, rheumatoid arthritis and certain cancers. The introduction of an effective therapeutic intervention provides a cause-effect starting point around which a model of pathogenesis could be constructed, comple...

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Increased Chromogranin A Cell Density in the Large Intestine of Patients with Irritable Bowel Syndrome after Receiving Dietary Guidance

Cited by 24 publications

References 53 publications

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Changes in duodenal enteroendocrine cells in patients with irritable bowel syndrome following dietary guidance

Dietary guidance normalizes large intestinal endocrine cell densities in patients with irritable bowel syndrome

Deciphering the pathophysiology of irritable bowel syndrome and functional gastrointestinal disorders—an alternative model for pathogenesis: cytokine controlled transepithelial multi-feedback loop

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