Confocal Endomicroscopy Shows Food-Associated Changes in the Intestinal Mucosa of Patients With Irritable Bowel Syndrome
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Background & aims We investigated suspected food intolerances in patients with irritable bowel syndrome (IBS) using confocal laser endomicroscopy (CLE) for real-time visualization of structural/functional changes in the intestinal mucosa after food challenge. Patients with functional changes after food challenge (CLE+) were placed on personalized exclusion diets and followed up for long-term symptom relief.Methods Thirty-six IBS patients with suspected food intolerance and 10 patients with Barrett's esophagus (controls) without IBS symptoms were examined by CLE at University Hospital Schleswig-Holstein (Kiel, Germany). Diluted food antigens were administered directly to the duodenal mucosa through the working channel of the endoscope. Epithelial breaks, intervillous spaces, and the number of intraepithelial lymphocytes (IEL) were measured before and after the food challenge. CLE+ patients were placed on exclusion diets, given symptom score questionnaires, and followed up for 1 year; controls resumed their previous diet.Results CLE showed a real-time response to food antigens in 22 of 36 patients; no responses were observed in 14 of 36 patients (CLE-) or any of the controls. Baseline IELs were significantly higher in CLE+ than CLE- subjects (P = .004); numbers increased significantly after food challenge (P = .0008). Within 5 minutes of exposure of CLE+ patients to food antigens, IELs increased, epithelial leaks/gaps formed, and intervillous spaces widened. Epithelial leaks and intervillous spaces also increased significantly in CLE+ vs baseline (both P < .001). The concordance of IELs measured by CLE and conventional histology was 70.6%; they did not correlate (P = .89; r(2) = 0.027). Symptom scores improved more than 50% in CLE+ patients after a 4-week exclusion diet and increased to 74% at 12 months; symptoms continued in CLE- patients.Conclusions Based on CLE analysis of IBS patients with a suspected food intolerance, exposure to candidate food antigens caused immediate breaks, increased intervillous spaces, and increased IELs in the intestinal mucosa. These changes are associated with patient responses to exclusion diets. Registered at clinicaltrials.gov (registration number: NCT01692613).
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Removal of the reacting antigen from the diet improved symptoms significantly.
“Removal of the reacting antigen from the diet improved symptoms significantly.67”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [67]
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- Authors
- Fritscher-Ravens, A., Schuppan, D., Ellrichmann, M., Schoch, S., Röcken, C., Brasch, J., Bethge, J., Böttner, M., Klose, J., & Milla, P. J.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- University Hospital Schleswig-Holstein (DE)
- University College London (GB)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 147
- Issue
- 5
- Pages
- 1012-1020.e4
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W1976947921
- Cited by
- 329
- References
- 45
- Citations by year
- 2026: 25 · 2025: 24 · 2024: 23 · 2023: 21 · 2022: 25 · 2021: 41 · 2020: 33 · 2019: 21 · 2018: 28 · 2017: 26 · 2016: 34 · 2015: 24 · 2014: 4
- FWCI
- 29.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- irritable bowel syndrome, food intolerance, confocal laser endomicroscopy, food challenge, intestinal mucosa, intraepithelial lymphocytes, intervillous space, elimination diet, duodenal mucosa, Barrett's esophagus, symptom relief, food antigens, intestinal permeability, villous atrophy
- MeSH terms
- Adult, Aged, Duodenum, Feasibility Studies, Female, Food, Food Hypersensitivity, Humans, Immunologic Tests, Intestinal Mucosa, Male, Middle Aged, Pilot Projects, Predictive Value of Tests, Surveys and Questionnaires, Time Factors, Endoscopy, Gastrointestinal, Treatment Outcome, Microscopy, Confocal, Irritable Bowel Syndrome, Young Adult
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