Confocal laser endomicroscopy detects colonic inflammation in patients with irritable bowel syndrome: a prospective study

Abstract

Background and aims Irritable bowel syndrome (IBS) is considered to be a functional disease, but recent data indicate measurable organic alterations. We aimed to determine the presence of colorectal mucosa microinflammation in vivo via probe-confocal laser endomicroscopy (pCLE) and histological evaluation in IBS patients. Methods This was a prospective, controlled, nonrandomized single-blind diagnostic trial performed in a tertiary institution. pCLE images and targeted biopsy of each colon segment obtained during colonoscopies of IBS patients and controls were analyzed for inflammatory changes. Biopsies were classified using the Geboes scale, and the odds ratio and overall diagnostic accuracy were calculated. Results During the 15-month study period, 37 patients were allocated to each group. The mean age was 53.1 ± 14.3 years; 64.9 % were female. Signs of colonic mucosa inflammation were evident on 65.8 % of pCLE images from IBS patients compared to 23.4 % of images from controls (OR 6.28; 4.14–9.52; P < 0.001). In total, 20/37 patients had microinflammation via pCLE in ≥ 3 colon segments in the IBS group, compared to 1/37 in the control group. A Geboes score > 0 was attributed to 60.8 % of biopsies from patients in the IBS group compared to 27.5 % of biopsies from the control group. The sensitivity, specificity, positive and negative predictive values, observed and interrater agreement of pCLE-detected inflammatory changes in IBS using histology as gold standard were 76 %, 91 %, 76 %, 91 %, 86.5 %, and 66.8 %, respectively. Conclusions Patients with IBS have a six-fold higher prevalence of colorectal mucosa microinflammation than healthy controls. pCLE might be a reliable method to detect colorectal mucosa microinflammation in IBS patients.

Irritable Bowel Syndrome and Functional Dyspepsia: Different Ends of the Same Spectrum of Intestinal Barrier Dysfunction?

“…Small intestinal barrier function has also received considerable attention as a potential pathomechanisms in irritable bowel syndrome (IBS) (2), and this in fact predates similar hypotheses with regards to FD. More interestingly, other studies in patients with IBS using confocal laser endomicroscopy have demonstrated largely similar barrier defects in the distal duodenum (3), terminal ileum (4) and colon (5) to those observed in the Nojkov study in FD patients.…”

The trace aminergic system: a gender-sensitive therapeutic target for IBS?

“…While similar studies in humans are lacking, it has been reported that neutrophil counts in colonic biopsies of patients with IBS are significantly increased compared to control [39], which may in turn result in increased myeloperoxidase levels, for example, in the colon tissue. Additionally, a very recent study utilising confocal laser endomicroscopy, reported that patients with IBS have a six-fold higher prevalence of colorectal mucosa micro-inflammation than healthy controls [193]. Considering that inflammation and oxidative stress are linked, often occurring in tandem, it is likely that local effects of oxidative damage/stress are implicated in IBS-related gastrointestinal symptomology.…”

The Application of Probe-Based Confocal Laser Endomicroscopy as a Diagnostic Tool in Choledochoscopic Gallbladder-Preserving Surgery

“…The shape of probe-based CLE (pCLE) and needle-based CLE makes possible to pass through most kinds of endoscopic channels, which greatly increases the scope usage. Currently, this tech-nique is used in diagnosis in various digestive organs, including esophagus, stomach, duodenum, colon-rectum, biliary and pancreatic duct, pancreas, and liver [14][15][16][17][18][19][20][21][22][23][24][25]. Its accuracy in diagnosis of Barrett's esophagus, pancreatic cystic degeneration, bile duct stricture, and other diseases is comparable to the histological diagnosis.…”