Background
Altered intestinal permeability and mucosal inflammation have been reported in irritable
bowel syndrome (IBS) patients. Increased cell extrusion in the epithelium as measured
by epithelial gaps may be associated with barrier dysfunction and may lead to mucosal
inflammation. Confocal laser endomicroscopy can be used to identify and quantitate
epithelial gaps in the small intestine.
Objective
To determine the epithelial gap density in IBS and healthy control patients.
Design
Prospective, controlled cohort study.
Setting
A tertiary referral center.
Patients
In IBS and control patients undergoing routine colonoscopy, probe-based confocal laser
endomicroscopy was used to image the terminal ileum.
Main Outcome Measurements
The primary outcome was the density of epithelial gaps (gaps/cells counted) in adequately
imaged villi using pCLE. Images were reviewed by 2 blinded reviewers.
Results
We recruited 18 healthy controls and 16 IBS patients. The median epithelial gap densities
for control and IBS patients were 6 and 32 gaps per 1000 cells, respectively (P < .001). There was a trend toward higher gap density in female (P = .07) and younger (ρ = −0.43, P = .07) patients. Using 3% (90% of the control population) as the cutoff for abnormal
gap density, we found the diagnostic accuracy for IBS to be as follows: 62% sensitivity,
89% specificity, 83% positive predictive value, and 73% negative predictive value.
Limitations
A single-center study, small number of patients.
Conclusions
IBS patients have significantly more epithelial gaps in their small intestine compared
with healthy controls, which suggests that increased epithelial cell extrusion may
be a cause of altered intestinal permeability observed in IBS.
Abbreviations:
CLE (confocal laser endomicroscopy), IBD (inflammatory bowel disease), IBS (irritable bowel syndrome), pCLE (probe-based confocal laser endomicroscopy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 28, 2013
Accepted:
November 5,
2012
Received:
July 7,
2012
Footnotes
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. Dr Turcotte is a recipient of the Alberta Innovates Health Solutions (AIHS) Clinician Researcher Fellowship. Stephanie Mah is a recipient of the AIHS Summer Studentship. Dr Liu is a recipient of the Canadian Institutes of Health Research New Investigator Salary award. This work was supported in part by a grant to Dr Liu from the University of Alberta Hospital Foundation and a grant to Dr. Fedorak from the Canadian Foundation for Innovation.
See CME section; p. 636.
If you would like to chat with an author of this article, you may contact Dr Liu at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
