Histopathological alterations in irritable bowel syndrome

Kirsch, Richard; Riddell, Robert H.

doi:10.1038/modpathol.3800704

Cited by 46 publications

(34 citation statements)

References 64 publications

(133 reference statements)

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“…We use different methods of bowel preparation in these two procedures; a phosphate enema for flexible sigmoidoscopy and Kleanprep for colonoscopy. There have been reports that bowel preparations may be responsible for histological changes17 with both enemas18 and colonoscopy sodium phosphate-containing bowel preparations 19 20. However, despite the use of these two different preparations, all biopsies were reported histologically as normal so there were no apparent changes induced due the type of preparation used.…”

Section: Discussionmentioning

confidence: 99%

Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain

Akbar

Yiangou

Facer

et al. 2008

Gut

452

342

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Objective:The capsaicin receptor TRPV1 (transient receptor potential vanilloid type-1) may play an important role in visceral pain and hypersensitivity states. In irritable bowel syndrome (IBS), abdominal pain is a common and distressing symptom where the pathophysiology is still not clearly defined. TRPV1-immunoreactive nerve fibres were investigated in colonic biopsies from patients with IBS, and this was related to abdominal pain.Methods:Rectosigmoid biopsies were collected from 23 IBS patients fulfilling Rome II criteria, and from 22 controls. Abdominal pain scores were recorded using a validated questionnaire. TRPV1-, substance P- and neuronal marker protein gene product (PGP) 9.5-expressing nerve fibres, mast cells (c-kit) and lymphocytes (CD3 and CD4) were quantified, following immunohistochemistry with specific antibodies. The biopsy findings were related to the abdominal pain scores.Results:A significant 3.5-fold increase in median numbers of TRPV1-immunoreactive fibres was found in biopsies from IBS patients compared with controls (p<0.0001). Substance P-immunoreactive fibres (p = 0.01), total nerve fibres (PGP9.5) (p = 0.002), mast cells (c-kit) (p = 0.02) and lymphocytes (CD3) (p = 0.03) were also significantly increased in the IBS group. In multivariate regression analysis, only TRPV1-immuno-reactive fibres (p = 0.005) and mast cells (p = 0.008) were significantly related to the abdominal pain score.Conclusions:Increased TRPV1 nerve fibres are observed in IBS, together with a low-grade inflammatory response. The increased TRPV1 nerve fibres may contribute to visceral hypersensitivity and pain in IBS, and provide a novel therapeutic target.

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Section: Discussionmentioning

confidence: 99%

Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain

Akbar

Yiangou

Facer

et al. 2008

Gut

452

342

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“…paratuberculosis-infected bovine macrophages (74), the hyporesponsiveness in ileal lymphocytes from Mycobacterium avium subsp. paratuberculosis-infected cows (75), abnormalities in the regulation of cytokine expression (9,13,16,30,31,65,73), the perturbation of macrophage activation and apoptosis (13,15), and the impairment of nitric oxide responsiveness (61 (33,35,68). Local and systemic immune dysfunctions in humans are well-described features of Crohn's disease (39,46).…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium avium Subspecies paratuberculosis Infection in Cases of Irritable Bowel Syndrome and Comparison with Crohn's Disease and Johne's Disease: Common Neural and Immune Pathogenicities

Scanu¹,

et al. 2007

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Mycobacterium avium subsp. paratuberculosis causes Johne's disease, a systemic infection and chronic inflammation of the intestine that affects many species, including primates. Infection is widespread in livestock, and human populations are exposed. Johne's disease is associated with immune dysregulation, with involvement of the enteric nervous system overlapping with features of irritable bowel syndrome in humans. The present study was designed to look for an association between Mycobacterium avium subsp. paratuberculosis infection and irritable bowel syndrome. Mucosal biopsy specimens from the ileum and the ascending and descending colon were obtained from patients with irritable bowel syndrome attending the University of Sassari, Sassari, Sardinia, Italy. Crohn's disease and healthy control groups were also included. Mycobacterium avium subsp. paratuberculosis was detected by IS900 PCR with amplicon sequencing. Data on the potential risk factors for human exposure to these pathogens and on isolates from Sardinian dairy sheep were also obtained. Mycobacterium avium subsp. paratuberculosis was detected in 15 of 20 (75%) patients with irritable bowel syndrome, 3 of 20 (15%) healthy controls, and 20 of 23 (87%) people with Crohn's disease (P ‫؍‬ 0.0003 for irritable bowel syndrome patients versus healthy controls and P ‫؍‬ 0.0000 for Crohn's disease patients versus healthy controls). One subject in each group had a conserved single-nucleotide polymorphism at position 247 of IS900 that was also found in isolates from seven of eight dairy sheep. There was a significant association (P ‫؍‬ 0.0018) between Mycobacterium avium subsp. paratuberculosis infection and the consumption of handmade cheese. Mycobacterium avium subsp. paratuberculosis is a candidate pathogen in the causation of a proportion of cases of irritable bowel syndrome as well as in Crohn's disease.

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“…the closed eye sign in IBS), C-reactive protein, fecal calprotectin, and high-resolution ultrasonography are considered objective helpful parameters while endoscopy with biopsy should be ‘normal’, but may confuse in detail because mild neuroendocrine and inflammatory histologic alterations may be visible also in the IBS [5]. Furthermore, acute diverticulitis starts from a microperforation beyond closure of the neck of the diverticulum by a fecolith (fig.…”

Section: Introductionmentioning

confidence: 99%

The Gastroenterologist’s View

Lembcke¹

2012

Dig Dis

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The traditional view that recurrent episodes of diverticulitis lead to progressively complicated disease resulting in a disadvantageous course, more difficult, complicated operations and lethal outcomes did not stand the test of evidence. Only a minority of patients with acute diverticulitis will ever require surgery, and if so, this occurs during or early after the first episode. Complications and recurrence of disease after surgery are enumerable. Strong indicators favoring sigmoid colectomy are major abscess, free air, and fistula, i.e. perforating disease. This occurs predominantly at the initial presentation, frequently in younger or immunosuppressed patients. Important differential diagnoses must be considered both for initial diagnosis of diverticulitis and for recurrent episodes. Conservative management of recurrent diverticulitis is safe and best guided by gastroenterological expertise. Sophisticated ultrasound experience as a part of this competence allows detailed evaluation of the local status and the best evidence in the literature for diagnosing diverticulitis is on US. In practice, however, the question of perforating diverticulitis is adequately answered by subtle CT scan. Medical therapy is usually the treatment of choice for recurrent diverticulitis. Avoidance of drugs bearing the hazard of perforation (e.g. NSAIDs) is emphasized, and smoking is strongly discouraged. A mathematical model based on published data shows that patients with recurrent diverticulitis overall (only) profit from surgery if they are hit by four episodes during the course of disease. This is where theory and reality (should) meet.

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Histopathological alterations in irritable bowel syndrome

Cited by 46 publications

References 64 publications

Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain

Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain

Mycobacterium avium Subspecies paratuberculosis Infection in Cases of Irritable Bowel Syndrome and Comparison with Crohn's Disease and Johne's Disease: Common Neural and Immune Pathogenicities

The Gastroenterologist’s View

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