Confocal Endomicroscopy Shows Food-Associated Changes in the Intestinal Mucosa of Patients With Irritable Bowel Syndrome

Fritscher-Ravens, Annette; Schuppan, Detlef; Ellrichmann, Mark; Schoch, Stefan; Röcken, Christoph; Brasch, Jochen; Bethge, Johannes; Böttner, Martina; Klose, Julius; Milla, Peter J.

doi:10.1053/j.gastro.2014.07.046

Cited by 271 publications

(261 citation statements)

References 42 publications

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“…A gluten-free diet was also shown to improve IBS-related QOL from baseline in some patients with IBS [43]. This may partly be related to GI mucosal changes observed in patients with IBS with a suspected food intolerance; these changes include epithelial barrier disruptions, fluid secretion into the GI lumen, and an influx of intraepithelial lymphocytes [44].…”

Section: Gluten-free Dietsmentioning

confidence: 95%

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Harris

Baffy

2017

Postgraduate Medicine

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Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS. ARTICLE HISTORY

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Section: Gluten-free Dietsmentioning

confidence: 95%

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Harris

Baffy

2017

Postgraduate Medicine

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“…In this issue of Gastroenterology, Fritscher-Ravens et al 14 further extend our ability to observe single cell inflammatory change and epithelial gap formation in patients with intolerance to specific food groups. They further explore the ability of this technology to identify food allergens and predict response to specific food elimination diets.…”

mentioning

confidence: 86%

Imaging the Leaky Gut

et al. 2014

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“…Fluorescence endomicroscopy also enables observation of gaps or breaks in the intestinal epithelial lining [59][60][61] . For patients with IBS 60,61 the leakage of intravenous fluorescein into the lumen has been visualized in real time 61 , indicating that endomicroscopy can be used to monitor dynamic, cellular level changes in gut function and permeability.…”

Section: Microbiota Changesmentioning

confidence: 99%

“…For patients with IBS 60,61 the leakage of intravenous fluorescein into the lumen has been visualized in real time 61 , indicating that endomicroscopy can be used to monitor dynamic, cellular level changes in gut function and permeability. In a study of EED in 41 Zambian adults using the Pentax ISC-1000 endo microscope 4 , only 8 (20%) exhibited no luminal leakage of fluorescein and only 2 (5%) showed no fluorescein plumes.…”

Section: Microbiota Changesmentioning

confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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| Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques -which can provide minimally invasive or noninvasive alternatives to biopsy -could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care. Members of the board and experts met to discuss the horizon scan in London, UK, in November 2015 and San Francisco, USA, in February 2016. Literature searches were performed using Web of Science, as well as through the advice of the advisory board and experts. The results of the horizon scan are presented in this Consensus Statement, which entails a review of EED, a discussion of technologies deemed relevant to EED (based on literature searches and the opinions of the advisory board and experts), and a series of recommendations for the future application of the rele vant technologies to the study and diagnosis of EED. In the Recommendations section, each technology has been assessed according to its suitability for application to EED and this assessment includes an evaluation of the cost, invasiveness and appropriateness for developing countries of each device and/or technique. This assessment was performed in a qualitative manner based on currently available information (for example, the present cost and size of the devices) and the opinions of the authors as to feasible future develop ment. Technique suitability for use in developing countries was determined in a qualitative manner after consideration of the need for advanced infrastructure and high levels of training for either system use or data analysis. Probable deployment time scales have also been assigned to each technique based on the current states of development and the degree of valid ation work that will be required before application to EED. These timescales have been tentatively defined as short-term (suitable for deployment immediately or within ~1 year), mediumterm (suit able for deployment within ~1-3 years) and long-term (suitable for deployme...

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Confocal Endomicroscopy Shows Food-Associated Changes in the Intestinal Mucosa of Patients With Irritable Bowel Syndrome

Cited by 271 publications

References 42 publications

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Imaging the Leaky Gut

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

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