51
|
Ringel Y. The Gut Microbiome in Irritable Bowel Syndrome and Other Functional Bowel Disorders. Gastroenterol Clin North Am 2017; 46:91-101. [PMID: 28164856 DOI: 10.1016/j.gtc.2016.09.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Emerging data from epidemiologic, microbiome, and physiology research in patients with functional bowel disorders (FBDs) provide evidence for a linkage between alterations in the intestinal microbiota and FBDs. However, currently most of the data is based on association studies, and the causality role of the microbiota in these disorders is not established. Growing evidence for compositional changes and the increasing recognition of the association between the intestinal microbiota and gut-brain functions that are relevant to the pathophysiology and/or clinical symptoms of FBDs have led to increased interest in manipulating the intestinal microbiota for the treatment of these disorders.
Collapse
Affiliation(s)
- Yehuda Ringel
- Department of Gastroenterology, Beilinson Hospital, Petach Tikva 49100, Israel; School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC 27599, USA.
| |
Collapse
|
52
|
Xue Y, Zhang S, Du M, Zhu MJ. Dandelion extract suppresses reactive oxidative species and inflammasome in intestinal epithelial cells. J Funct Foods 2017. [DOI: 10.1016/j.jff.2016.11.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
53
|
Camilleri M, Ford AC. Irritable Bowel Syndrome: Pathophysiology and Current Therapeutic Approaches. Handb Exp Pharmacol 2017; 239:75-113. [PMID: 27995391 DOI: 10.1007/164_2016_102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Irritable bowel syndrome (IBS) is a prevalent condition affecting 10-20% of adults in most countries; IBS results in significant morbidity and health care costs. IBS is a disorder of the brain-gut axis, and recent insights into the pathophysiological mechanisms include altered bile acid metabolism, neurohormonal regulation, immune dysfunction, alterations in the epithelial barrier, and secretory properties of the gut. There remains a significant unmet need for effective treatments, particularly for the pain component of IBS, although the introduction of drugs directed at secretion, motility, and a nonabsorbable antibiotic provides an option for the bowel dysfunction in IBS.
Collapse
Affiliation(s)
- Michael Camilleri
- Department of Medicine, Pharmacology, and Physiology, Division of Gastroenterology, Mayo Clinic College of Medicine, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), 200 First Street S.W, Rochester, MN, 55905, USA.
| | - Alexander C Ford
- Department of Gastroenterology and Honorary Consultant Gastroenterologist, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds and Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, Leeds, UK
| |
Collapse
|
54
|
Gervasoni J, Schiattarella A, Giorgio V, Primiano A, Russo C, Tesori V, Scaldaferri F, Urbani A, Zuppi C, Persichilli S. Validation of an LC-MS/MS Method for Urinary Lactulose and Mannitol Quantification: Results in Patients with Irritable Bowel Syndrome. DISEASE MARKERS 2016; 2016:5340386. [PMID: 28070137 PMCID: PMC5192291 DOI: 10.1155/2016/5340386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 12/20/2022]
Abstract
Aim. Lactulose/mannitol ratio is used to assess intestinal barrier function. Aim of this work was to develop a robust and rapid method for the analysis of lactulose and mannitol in urine by liquid chromatography coupled to tandem mass spectrometry. Lactulose/mannitol ratio has been measured in pediatric patients suffering from irritable bowel syndrome. Methods. Calibration curves and raffinose, used as internal standard, were prepared in water : acetonitrile 20 : 80. Fifty μL of urine sample was added to 450 μL of internal standard solution. The chromatographic separation was performed using a Luna NH2 column operating at a flow rate of 200 μL/min and eluted with a linear gradient from 20% to 80% water in acetonitrile. Total run time is 9 minutes. The mass spectrometry operates in electrospray negative mode. Method was fully validated according to European Medicine Agency guidelines. Results and Conclusions. Linearity ranged from 10 to 1000 mg/L for mannitol and 2.5 to 1000 mg/L for lactulose. Imprecision in intra- and interassay was lower than 15% for both analytes. Accuracy was higher than 85%. Lactulose/mannitol ratio in pediatric patients is significantly higher than that measured in controls. The presented method, rapid and sensitive, is suitable in a clinical laboratory.
Collapse
Affiliation(s)
- Jacopo Gervasoni
- UOC Laboratorio Analisi I, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Valentina Giorgio
- Pediatria, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Aniello Primiano
- UOC Laboratorio Analisi I, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Consuelo Russo
- Pediatria, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Valentina Tesori
- UOC di Medicina Interna Gastroenterologia e Malattie del Fegato, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Franco Scaldaferri
- UOC di Medicina Interna Gastroenterologia e Malattie del Fegato, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Andrea Urbani
- UOC Laboratorio Analisi I, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Cecilia Zuppi
- UOC Laboratorio Analisi I, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Silvia Persichilli
- UOC Laboratorio Analisi I, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| |
Collapse
|
55
|
Maekawa T, Ishijima AS, Ida M, Izumo T, Ono Y, Shibata H, Abe S. Prophylactic Effect of Lactobacillus pentosus strain S-PT84 on Candida Infection and Gastric Inflammation in a Murine Gastrointestinal Candidiasis Model. Med Mycol J 2016; 57:E81-E92. [PMID: 27904056 DOI: 10.3314/mmj.16-00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We previously showed a prophylactic effect of Lactobacillus pentosus strain S-PT84 against oral candidiasis in mice. In the present study, we evaluated the protective effect of S-PT84 against Candida infection of the gastrointestinal tract. As the first step, we used an in vitro assay to compare the inhibitory effects of several lactobacilli (S-PT84 and Lactobacillus pentosus type strain JCM1558T, Lactobacillus gasseri type strain JCM1131T and Lactobacillus casei type strain JCM1134T) on mycelial growth of Candida albicans. S-PT84 directly adhered to Candida cells and showed the strongest growth-inhibitory activity among the tested Lactobacillus strains. In the second experiment, we used an in vivo assay to evaluate the effect of S-PT84 ingestion on severity score of stomach lesion and gastric inflammation in a mouse model of gastrointestinal candidiasis. The severity scores were significantly improved by oral administration of S-PT84 (6 mg/ 200 μL), consistent with decreased coverage of stomach lesions by patchy whitish plaques. The attenuation of stomach lesion severity by S-PT84 was more pronounced than that obtained with L. gasseri type strain JCM1131T, consistent with the results of the above in vitro study. Histological analysis also indicated that S-PT84 prevented the adhesion of C. albicans to the stomach surface and suppressed stomach inflammation caused by neutrophil infiltration. Furthermore, S-PT84 also suppressed the vascular permeability observed in Candida-infected stomach. These results suggest that oral administration of S-PT84 might be effective not only in inhibiting Candida infection but also in preventing gastric inflammation induced by Candida infection.
Collapse
|
56
|
Chumpitazi BP, Shulman RJ. Underlying molecular and cellular mechanisms in childhood irritable bowel syndrome. Mol Cell Pediatr 2016; 3:11. [PMID: 26883355 PMCID: PMC4755958 DOI: 10.1186/s40348-016-0036-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/04/2016] [Indexed: 12/17/2022] Open
Abstract
Irritable bowel syndrome (IBS) affects a large number of children throughout the world. The symptom expression of IBS is heterogeneous, and several factors which may be interrelated within the IBS biopsychosocial model play a role. These factors include visceral hyperalgesia, intestinal permeability, gut microbiota, psychosocial distress, gut inflammation, bile acids, food intolerance, colonic bacterial fermentation, and genetics. The molecular and cellular mechanisms of these factors are being actively investigated. In this mini-review, we present updates of these mechanisms and, where possible, relate the findings to childhood IBS. Mechanistic elucidation may lead to the identification of biomarkers as well as personalized childhood IBS therapies.
Collapse
Affiliation(s)
- Bruno P Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, TX, USA.
- Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, 6621 Fannin Street, 77030, Houston, TX, USA.
| | - Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, 77030, TX, USA.
- Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, 6621 Fannin Street, 77030, Houston, TX, USA.
- Children's Nutrition Research Center, 1100 Bates Avenue, Houston, 77030, TX, USA.
| |
Collapse
|
57
|
Abstract
OBJECTIVE An adequate bowel preparation is essential for a successful colonoscopy, but to date, only scarce information exists on the impact of the bowel cleansing on the gut microbiota, in particular, 1 month after the procedure. PATIENTS AND METHODS Through 16S rDNA Ion Torrent profiling of fecal samples of 10 patients, we evaluated changes that occurred in the gut microbiota composition immediately after a 4 liter polyethylene glycol-based (SELG Esse) bowel lavage and 1 month thereafter. We studied the gut microbiota at the phylum, class, and family level. RESULTS At the phyla level, we found a significant decrease in Firmicutes abundance and an increase in Proteobacteria abundance immediately after the colon cleansing and 1 month after the colonoscopy, whereas, at the class level, a significant increase in γ-Proteobacteria immediately after the colonoscopy was observed. Interestingly, 1 month after the endoscopic examination, this bacterial class was decreased 2.5-fold compared with samples before colonoscopy, as well as α-Proteobacteria. At the family level, a significant reduction in Lactobacillaceae and an increase in Enterobacteriaceae abundance were observed immediately after the colonoscopy, whereas 1 month after the bowel cleansing, these families were significantly lower compared with samples collected before the colonoscopy. Moreover, the abundance of Rikenellaceae and Eubacteriaceae has been observed to be significantly higher compared with samples collected before the bowel lavage. Finally, Streptococcaceae were increased 4.0-fold 1 month after the bowel lavage compared with fecal samples collected before the colonoscopy. CONCLUSION We provide clear evidence that, in normal individuals, a high-volume polyethylene glycol bowel cleansing preparation has a long-lasting effect on the gut microbiota composition and homeostasis, in particular, with a decrease in the Lactobacillaceae abundance, a population of protective bacteria. Further studies are required to assess whether these changes have any metabolic, immunological, or clinical consequence.
Collapse
|
58
|
Czyzewski DI, Self MM, Williams AE, Weidler EM, Blatz AM, Shulman RJ. Maintenance of Pain in Children With Functional Abdominal Pain. J Pediatr Gastroenterol Nutr 2016; 62:393-8. [PMID: 26301615 PMCID: PMC4761339 DOI: 10.1097/mpg.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). METHODS Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. RESULTS Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. CONCLUSIONS The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.
Collapse
Affiliation(s)
- Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Mariella M. Self
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Amy E. Williams
- Indiana University School of Medicine & Riley Child and Adolescent Psychiatry Clinic, Indianapolis, Indiana
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
- Children’s Nutrition Research Center, Houston, Texas
| | - Allison M. Blatz
- George Washington School of Medicine and Health Sciences, Washington, D.C
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
- Children’s Nutrition Research Center, Houston, Texas
| |
Collapse
|
59
|
Sinagra E, Pompei G, Tomasello G, Cappello F, Morreale GC, Amvrosiadis G, Rossi F, Lo Monte AI, Rizzo AG, Raimondo D. Inflammation in irritable bowel syndrome: Myth or new treatment target? World J Gastroenterol 2016; 22:2242-2255. [PMID: 26900287 PMCID: PMC4734999 DOI: 10.3748/wjg.v22.i7.2242] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/28/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.
Collapse
|
60
|
Yu J, Ordiz MI, Stauber J, Shaikh N, Trehan I, Barnell E, Head RD, Maleta K, Tarr PI, Manary MJ. Environmental Enteric Dysfunction Includes a Broad Spectrum of Inflammatory Responses and Epithelial Repair Processes. Cell Mol Gastroenterol Hepatol 2015; 2:158-174.e1. [PMID: 26973864 PMCID: PMC4769221 DOI: 10.1016/j.jcmgh.2015.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Environmental enteric dysfunction (EED), a chronic diffuse inflammation of the small intestine, is associated with stunting in children in the developing world. The pathobiology of EED is poorly understood because of the lack of a method to elucidate the host response. This study tested a novel microarray method to overcome limitation of RNA sequencing to interrogate the host transcriptome in feces in Malawian children with EED. METHODS In 259 children, EED was measured by lactulose permeability (%L). After isolating low copy numbers of host messenger RNA, the transcriptome was reliably and reproducibly profiled, validated by polymerase chain reaction. Messenger RNA copy number then was correlated with %L and differential expression in EED. The transcripts identified were mapped to biological pathways and processes. The children studied had a range of %L values, consistent with a spectrum of EED from none to severe. RESULTS We identified 12 transcripts associated with the severity of EED, including chemokines that stimulate T-cell proliferation, Fc fragments of multiple immunoglobulin families, interferon-induced proteins, activators of neutrophils and B cells, and mediators that dampen cellular responses to hormones. EED-associated transcripts mapped to pathways related to cell adhesion, and responses to a broad spectrum of viral, bacterial, and parasitic microbes. Several mucins, regulatory factors, and protein kinases associated with the maintenance of the mucous layer were expressed less in children with EED than in normal children. CONCLUSIONS EED represents the activation of diverse elements of the immune system and is associated with widespread intestinal barrier disruption. Differentially expressed transcripts, appropriately enumerated, should be explored as potential biomarkers.
Collapse
Key Words
- %L, lactulose permeability
- EED, environmental enteric dysfunction
- Environmental Enteropathy
- FARMS, factor analyses for robust microarray summarization
- Fecal Transcriptome
- G-CSF, granulocyte colony–stimulating factor
- HAZ, height-for-age z score
- IRON, iterative rank order normalization
- Intestinal Inflammation
- KEGG, Kyoto Encyclopedia of Genes and Genomes
- RMA, robust multi-array average
- Stunting
- dHAZ, change in height-for-age z score
- mRNA, messenger RNA
- qPCR, quantitative polymerase chain reaction
Collapse
Affiliation(s)
- Jinsheng Yu
- Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - M. Isabel Ordiz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Stauber
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Nurmohammad Shaikh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Indi Trehan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Erica Barnell
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Richard D. Head
- Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Ken Maleta
- Department of Community Health, College of Medicine, Blantyre, Malawi
| | - Phillip I. Tarr
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mark J. Manary
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri,Department of Community Health, College of Medicine, Blantyre, Malawi,Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas,Correspondence Address correspondence to: Mark J. Manary, MD, Department of Pediatrics, Washington University School of Medicine, One Children's Place, St. Louis Children's Hospital St. Louis, Missouri 63110. fax: (314) 454-4345.Department of PediatricsWashington University School of MedicineSt. LouisMissouri 63110
| |
Collapse
|
61
|
Aich A, Afrin LB, Gupta K. Mast Cell-Mediated Mechanisms of Nociception. Int J Mol Sci 2015; 16:29069-92. [PMID: 26690128 PMCID: PMC4691098 DOI: 10.3390/ijms161226151] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 12/12/2022] Open
Abstract
Mast cells are tissue-resident immune cells that release immuno-modulators, chemo-attractants, vasoactive compounds, neuropeptides and growth factors in response to allergens and pathogens constituting a first line of host defense. The neuroimmune interface of immune cells modulating synaptic responses has been of increasing interest, and mast cells have been proposed as key players in orchestrating inflammation-associated pain pathobiology due to their proximity to both vasculature and nerve fibers. Molecular underpinnings of mast cell-mediated pain can be disease-specific. Understanding such mechanisms is critical for developing disease-specific targeted therapeutics to improve analgesic outcomes. We review molecular mechanisms that may contribute to nociception in a disease-specific manner.
Collapse
Affiliation(s)
- Anupam Aich
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Lawrence B Afrin
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kalpna Gupta
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| |
Collapse
|
62
|
Barreto M, Evangelisti M, Principessa L, Simmaco M, Negro V, Lionetto L, Campisano M, Villa MP. Intestinal permeability in children with recurrent respiratory and gastrointestinal symptoms. J Paediatr Child Health 2015; 51:1214-20. [PMID: 26044914 DOI: 10.1111/jpc.12927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2015] [Indexed: 01/31/2023]
Abstract
AIM Increased intestinal permeability has been reported in asthmatic subjects as well as in patients with gastrointestinal disease, thus suggesting the involvement of all the mucosal immune system. We aimed to assess intestinal permeability according to recurrent respiratory and gastrointestinal symptoms in children with asthma and children with functional gastrointestinal disorders (FGIDs). METHODS In 108 outpatients aged 3-14 years (45 asthmatic, 63 with FGIDs), we measured the urinary lactulose/mannitol (L/M) ratio, performed allergy skin prick tests and administered questionnaires for recurrent respiratory and gastrointestinal symptoms starting from at least 2 months which persisted over the previous 4 weeks. L/M ratios were compared with previously reported normal values yielded by our chromatographic method (liquid chromatography-mass spectrometry). RESULTS High L/M ratios (>0.030) were less frequent in asthmatic children than in children with FGIDs (9/45: 20% vs. 41/63: 65%, P < 0.001). High L/M ratios were associated with gastrointestinal symptoms in 8/9 asthmatic (P < 0.05) and 39/41 subjects with FGIDs (P < 0.005). L/M ratios were not associated with respiratory symptoms or atopy. In a regression model, a high L/M was predicted by low height, absence of asthma and presence of gastrointestinal symptoms (r = 0.72, P < 0.001). CONCLUSIONS Increased intestinal permeability is associated with recurrent gastrointestinal symptoms rather than with recurrent respiratory symptoms in both asthmatic children and those with FGIDs. Our findings do not support the hypothesis of mucosal intestinal damage following an inflammatory stimulus in the respiratory mucosa.
Collapse
Affiliation(s)
- Mario Barreto
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Melania Evangelisti
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Luigi Principessa
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Maurizio Simmaco
- Advanced Molecular Diagnostic Unit, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Valentina Negro
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostic Unit, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Martina Campisano
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| | - Maria Pia Villa
- Pediatric Unit Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, 'Sapienza' University, Rome, Italy
| |
Collapse
|
63
|
Common beans and cowpeas as complementary foods to reduce environmental enteric dysfunction and stunting in Malawian children: study protocol for two randomized controlled trials. Trials 2015; 16:520. [PMID: 26578308 PMCID: PMC4650393 DOI: 10.1186/s13063-015-1027-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022] Open
Abstract
Background Interventions to decrease the burden of childhood malnutrition are urgently needed, as millions of children die annually owing to undernutrition and hundreds of millions more are left cognitively and physically stunted. Environmental enteric dysfunction (EED), a pervasive chronic subclinical inflammatory condition among children that develops when complementary foods are introduced, places them at high risk of stunting, malabsorption, and poor oral vaccine efficacy. Improved interventions to reduce the burden of EED and stunting are expected to markedly improve the nutritional status and survival of children throughout resource-limited settings. Methods/Design We will conduct, in parallel, two prospective randomized controlled clinical trials to determine whether common beans or cowpeas improve growth, ameliorate EED, and alter the intestinal microbiome during a high-risk period in the lives of rural Malawian children. Study 1 will enroll children at 6 months of age and randomize them to receive common beans, cowpeas, or a standard complementary food for 6 months. Anthropometry will be compared among the three groups; EED will be assessed using a dual-sugar absorption test and by quantifying human intestinal mRNA for inflammatory messages; and the intestinal microbiota will be characterized by deep sequencing of fecal DNA, to enumerate host microbial populations and their metabolic capacity. Study 2 will enroll children 12–23 months old and follow them for 12 months, with similar interventions and assessments as Study 1. Discussion By amalgamating the power of rigorous clinical trials and advanced biological analysis, we aim to elucidate the potential of two grain legumes to reduce stunting and EED in a high-risk population. Legumes have potential as an affordable and effective complementary food intervention, given their cultural acceptability, nutritional content, and agricultural feasibility in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT02472262 and NCT02472301.
Collapse
|
64
|
Abstract
Irritable bowel syndrome (IBS) is the most prevalent and the best studied functional gastrointestinal disorder. The etiology and the pathogenesis of IBS are still not clear; however, recent studies have implicated a role for alterations in the intestinal microbiota (dysbiosis) in the pathophysiology of the disorder. Epidemiological observations have demonstrated that the development of IBS symptoms is often preceded by a disruption of the individual's normal intestinal microbiota, and microbiological studies have demonstrated compositional differences in the intestinal microbiota between patients with IBS patients and healthy controls. In addition, animal studies and a few recent human clinical studies have demonstrated that compositional changes in the intestinal microbiota in IBS are associated with relevant abnormal gastrointestinal and brain-gut axis functions that are often observed in patients with IBS. This article discusses points of interest from the current research on the microbiota-gut-brain interactions in IBS and highlights the relevance of the emerging data to our understanding of the disorder and the clinical implications for patients' care.
Collapse
|
65
|
Deberry JJ, Bielefeldt K, Davis BM, Szigethy EM, Hartman DJ, Coates MD. Abdominal pain and the neurotrophic system in ulcerative colitis. Inflamm Bowel Dis 2014; 20:2330-9. [PMID: 25358061 PMCID: PMC8524787 DOI: 10.1097/mib.0000000000000207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We undertook a study to test the hypothesis that inflammation alters peripheral sensory mechanisms, thereby contributing to chronic abdominal pain in ulcerative colitis (UC). METHODS Patients with UC and healthy individuals rated abdominal pain using a visual analog scale and completed surveys describing anxiety or depression (Hospital Anxiety and Depression Score) and gastrointestinal symptoms (Rome III questionnaire). Patient age, sex, and severity of inflammation were determined. Rectal biopsies were processed using immunohistochemical techniques to assess nerve fiber density and real-time PCR to determine transcript expression of neurotrophins (nerve growth factor, glial cell-derived neurotrophic factor, artemin, neurturin), ion channels (transient receptor potential vanilloid type 1, transient receptor potential ankyrin 1) and inflammatory mediators (tumor necrosis factor-α, interleukin [IL]-1β, IL-6, IL-10, IL-17). RESULTS A total of 77 patients with UC (27 female, 50 male) and 21 controls (10 female, 11 male) were enrolled. Patients with UC with pain had significantly higher depression scores than controls and patients with UC without pain (P < 0.05). There was no correlation between any of the inflammatory markers and pain scores. Visual analog scale pain scores significantly correlated with younger age, higher depression scores, increased expression of neurturin and decreased expression of transient receptor potential ankyrin 1 in the mucosa. Mucosal nerve fiber density did not correlate with any measures of inflammation or pain. Only higher depression scores independently predicted pain in UC (r > 0.5). CONCLUSIONS We did not observe changes in mucosal innervation and did not see a significant relationship between nerve fiber density, inflammatory mediators, neurotrophic factors, or mucosal ion channel expression and pain. In contrast, the importance of depression as the only independent predictor of pain ratings mirrors functional disorders, where central processes significantly contribute to symptom development and/or perpetuation.
Collapse
Affiliation(s)
- Jennifer J. Deberry
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Klaus Bielefeldt
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian M. Davis
- Department of Neurosciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eva M. Szigethy
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas J. Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Matthew D. Coates
- Department of Medicine, Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| |
Collapse
|
66
|
Srinath A, Young E, Szigethy E. Pain management in patients with inflammatory bowel disease: translational approaches from bench to bedside. Inflamm Bowel Dis 2014; 20:2433-49. [PMID: 25208108 DOI: 10.1097/mib.0000000000000170] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) that negatively affects quality of life and can lead to increased health-seeking behavior. Although abdominal pain has been traditionally attributed to inflammation, there is growing literature demonstrating the existence of functional abdominal pain in patients with IBD, of which there are a variety of potential causes. Thus, when approaching a patient with IBD who has abdominal pain, in addition to IBD-related complications (e.g., inflammation/stricture), it is important to screen for related contributors, including peripheral factors (visceral hypersensitivity, bacterial overgrowth, and bowel dysmotility) and centrally mediated neurobiological and psychosocial underpinnings. These central factors include psychological symptoms/diagnoses, sleep disturbance, and stress. Opioid-induced hyperalgesia (e.g., narcotic bowel syndrome) is also growing in recognition as a potential central source of abdominal pain. This review draws from clinical studies and animal models of colitis and abdominal pain to consider how knowledge of these potential etiologies can be used to individualize treatment of abdominal pain in patients with IBD, including consideration of potential novel treatment modalities for the future. Accurate assessment of the source(s) of pain in patients with IBD can help guide appropriate diagnostic workup and use of disease-modifying therapy.
Collapse
Affiliation(s)
- Arvind Srinath
- *Department of Pediatric Gastroenterology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania; †Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and ‡Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
67
|
The brain-gut axis in health and disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 817:135-53. [PMID: 24997032 DOI: 10.1007/978-1-4939-0897-4_6] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The interaction between the brain and the gut has been recognized for many centuries. This bidirectional interaction occurs via neural, immunological and hormonal routes, and is important not only in normal gastrointestinal function but also plays a significant role in shaping higher cognitive function such as our feelings and our subconscious decision-making. Therefore, it remains unsurprising that perturbations in normal signalling have been associated with a multitude of disorders, including inflammatory and functional gastrointestinal disorders, and eating disorders.
Collapse
|
68
|
Ryan KN, Stephenson KB, Trehan I, Shulman RJ, Thakwalakwa C, Murray E, Maleta K, Manary MJ. Zinc or albendazole attenuates the progression of environmental enteropathy: a randomized controlled trial. Clin Gastroenterol Hepatol 2014; 12:1507-13.e1. [PMID: 24462483 DOI: 10.1016/j.cgh.2014.01.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Environmental enteropathy (EE) is a subclinical condition among children in the developing world, characterized by T-cell infiltration of the small-bowel mucosa and diffuse villous atrophy. EE leads to macronutrient and micronutrient malabsorption and stunting, with a resultant increased risk for infection and reduced cognitive development. We tested the hypothesis that zinc and albendazole treatments would reduce the severity of EE in rural African children. METHODS In a randomized, double-blind, placebo-controlled trial in rural southern Malawi, asymptomatic children, 1 to 3 years old and at high risk for EE, received either a single dose of albendazole, a 14-day course of 20 mg zinc sulfate, or a placebo. Subjects were given the dual-sugar absorption test, and the ratio of lactulose to mannitol (L:M) in urine was used to determine the severity of EE at baseline and 34 days after completion of the assigned regimen. The primary outcome was the change in the L:M. RESULTS A complete set of urine samples was obtained from 222 of 234 children enrolled and analyzed. The mean baseline L:M was 0.32 ± 0.18 among all children and did not differ among groups (normal L:M range, <0.12). At the end of the study, the L:M ratio had increased more in the placebo group (0.12 ± 0.31) than in the zinc group (0.03 ± 0.20; P < .03) or the albendazole group (0.04 ± 0.22; P < .04). CONCLUSIONS Treatment with zinc or albendazole protects against a significant increase in the L:M ratio, a biomarker for EE, in asymptomatic rural Malawian children. These findings could provide insight into the etiology and pathogenesis of EE. Clinicaltrials.gov Number: NCT01440608.
Collapse
Affiliation(s)
- Kelsey N Ryan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin B Stephenson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Indi Trehan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Robert J Shulman
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Chrissie Thakwalakwa
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ellen Murray
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth Maleta
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Mark J Manary
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas; Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi.
| |
Collapse
|
69
|
Abstract
PURPOSE This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS). METHODS This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model. RESULTS IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep. CONCLUSION The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.
Collapse
Affiliation(s)
- Margaret Heitkemper
- Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, USA.
| | - Monica Jarrett
- Department of Biobehavioral Nursing & Health Systems, University of Washington, Seattle, USA
| | - Sang-Eun Jun
- College of Nursing, Keimyung University, Daegu, Korea
| |
Collapse
|
70
|
Sandhu BK, Paul SP. Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment. World J Gastroenterol 2014; 20:6013-23. [PMID: 24876724 PMCID: PMC4033441 DOI: 10.3748/wjg.v20.i20.6013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/20/2014] [Accepted: 03/19/2014] [Indexed: 02/07/2023] Open
Abstract
Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.
Collapse
|
71
|
Neilan NA, Garg UC, Schurman JV, Friesen CA. Intestinal permeability in children/adolescents with functional dyspepsia. BMC Res Notes 2014; 7:275. [PMID: 24886078 PMCID: PMC4022401 DOI: 10.1186/1756-0500-7-275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 04/17/2014] [Indexed: 01/05/2023] Open
Abstract
Background An altered intestinal mucosal barrier has been demonstrated in subsets of patients with IBS and FAP and may be an additional biological factor contributing to symptom generation in children with FD. The objective of this study was to determine if intestinal permeability is increased in children/adolescents with functional dyspepsia (FD) and whether intestinal permeability is correlated with mucosal inflammation and/or symptoms of anxiety or depression in this population. Methods A sugar absorption test was performed in 19 patients with FD and 19 controls. Anxiety and depression were assessed in both groups utilizing a standard questionnaire. In FD patients, duodenal mean and peak mast cell and eosinophil densities were determined. Results Intestinal permeability as measured by the sugar absorption test did not differ between children with FD and controls. In children with FD, there was no correlation between permeability and mast cell density, eosinophil density, anxiety scores, or depression scores, respectively. Conclusions Pediatric FD does not appear to be associated with increased small bowel intestinal permeability, however, there are some limitations to the current study. Trial registration ClinicalTrials.gov;
NCT00363597.
Collapse
Affiliation(s)
| | | | | | - Craig A Friesen
- Division of Gastroenterology, Hepatology, & Nutrition, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
| |
Collapse
|
72
|
Walker MM, Powell N, Talley NJ. Atopy and the gastrointestinal tract--a review of a common association in unexplained gastrointestinal disease. Expert Rev Gastroenterol Hepatol 2014; 8:289-99. [PMID: 24450399 DOI: 10.1586/17474124.2014.881716] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In addition to diseases conventionally associated with atopy there is increasing recognition that atopy is also linked to a spectrum of gastrointestinal (GI) manifestations, including food allergy, primary eosinophilic GI disease, functional gastrointestinal disorders, gluten interactions, gastroesophageal reflux disease and inflammatory bowel disease. These associations may be underpinned by shared genetic susceptibilities, initiation of related immune pathways and common patterns of exposure to environmental cues, including allergen/pathogen encounters and variations in the composition of the intestinal microbiota. Further scrutiny of GI diseases with prominent allergic-type immune responses may yet redefine treatment paradigms for these common and important atopy-associated diseases. Looking forward, interventions by manipulation of the microbiota or host immune responses hold promise, but there is still room for further exploration of this novel field of host susceptibility, host-microbe interactions and atopy-associated GI diseases.
Collapse
Affiliation(s)
- Marjorie M Walker
- School of Medicine & Public Health, University of Newcastle, Callaghan NSW 2308, Australia
| | | | | |
Collapse
|
73
|
Di Nardo G, Barbara G, Cucchiara S, Cremon C, Shulman RJ, Isoldi S, Zecchi L, Drago L, Oliva S, Saulle R, Barbaro MR, Stronati L. Neuroimmune interactions at different intestinal sites are related to abdominal pain symptoms in children with IBS. Neurogastroenterol Motil 2014; 26:196-204. [PMID: 24304324 DOI: 10.1111/nmo.12250] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuroimmune interactions and inflammation have been proposed as factors involved in sensory-motor dysfunction and symptom generation in adult irritable bowel syndrome (IBS) patients. In children with IBS and healthy controls, we measured ileocolonic mast cell infiltration and fecal calprotectin and evaluated the relationships between these parameters and abdominal pain symptoms and stooling pattern. METHODS Irritable bowel syndrome patients diagnosed according to Pediatric Rome III criteria and healthy controls kept a 2-week pain/stooling diary. Ileocolonic mucosal mast cells (MC) and MC in close proximity to nerve fibers (MC-NF) were identified immunohistochemically and quantified. Fecal calprotectin concentration was measured. KEY RESULTS 21 IBS patients and 10 controls were enrolled. The MC-NF count was significantly higher in the ileum (p = 0.01), right colon (p = 0.04), and left colon (p < 0.001) of IBS patients compared with controls. No differences in fecal calprotectin concentration were noted. Abdominal pain intensity score correlated with ileal MC count (r(s) = 0.47, p = 0.030) and right colon MC-NF count (r(s) = 0.52, p = 0.015). In addition, children with IBS with >3 abdominal pain episodes/week had greater ileal (p = 0.002) and right colonic (p = 0.01) MC counts and greater ileal (p = 0.05) and right colonic (p = 0.016) MC-NF counts than children with less frequent pain. No relationship was found between MC and MC-NF and fecal calprotectin or stooling pattern. CONCLUSIONS & INFERENCES Mast cells-nerve fibers counts are increased in the ileocolonic mucosa of children with IBS. Mast cells and MC-NF counts are related to the intensity and frequency of abdominal pain.
Collapse
Affiliation(s)
- G Di Nardo
- Department of Pediatrics, Pediatric Gastroenterology Unit, "Sapienza" University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
74
|
Williams AE, Czyzewski DI, Self MM, Shulman RJ. Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders? J Health Psychol 2013; 20:369-79. [PMID: 24155191 DOI: 10.1177/1359105313502564] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiety Inventory for Children, the Children's Somatization Inventory, and 2-week pain diaries (assessing pain frequency and maximum pain). Hierarchical regressions indicated that both trait anxiety and somatization were significantly related to maximum pain and pain frequency, with somatization explaining more variance. Trait anxiety did not significantly add to prediction above somatization. Assessment of somatization may assist with treatment planning for children with functional abdominal pain.
Collapse
Affiliation(s)
| | | | - Mariella M Self
- Baylor College of Medicine, USA Texas Children's Hospital, USA
| | - Robert J Shulman
- Baylor College of Medicine, USA Texas Children's Hospital, USA Children's Nutrition Research Center, USA
| |
Collapse
|
75
|
Carroll IM, Ringel-Kulka T, Ferrier L, Wu MC, Siddle JP, Bueno L, Ringel Y. Fecal protease activity is associated with compositional alterations in the intestinal microbiota. PLoS One 2013; 8:e78017. [PMID: 24147109 PMCID: PMC3798377 DOI: 10.1371/journal.pone.0078017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/16/2013] [Indexed: 12/23/2022] Open
Abstract
Objective Intestinal proteases carry out a variety of functions in the gastrointestinal (GI) tract. Studies have reported that elevated enteric proteases in patients with GI disease can alter intestinal physiology, however the origin (human vs. microbial) of elevated proteases in patients with GI disease is unclear. Aim The aim of this study was to investigate the association between protease activity and the microbiota in human fecal samples. Design In order to capture a wide range of fecal protease (FP) activity stool samples were collected from 30 IBS patients and 24 healthy controls. The intestinal microbiota was characterized using 454 high throughput pyro-sequencing of the 16S rRNA gene. The composition and diversity of microbial communities were determined and compared using the Quantitative Insights Into Microbial Ecology (QIIME) pipeline. FP activity levels were determined using an ELISA-based method. FP activity was ranked and top and bottom quartiles (n=13 per quartile) were identified as having high and low FP activity, respectively. Results The overall diversity of the intestinal microbiota displayed significant clustering separation (p = 0.001) between samples with high vs. low FP activity. The Lactobacillales, Lachnospiraceae, and Streptococcaceae groups were positively associated with FP activity across the entire study population, whilst the Ruminococcaceae family and an unclassified Coriobacteriales family were negatively associated with FP activity. Conclusions These data demonstrate significant associations between specific intestinal bacterial groups and fecal protease activity and provide a basis for further causative studies investigating the role of enteric microbes and GI diseases.
Collapse
Affiliation(s)
- Ian M. Carroll
- Division of Gastroenterology and Hepatology, Department of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tamar Ringel-Kulka
- Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Laurent Ferrier
- INRA, UMR1331 Toxalim, Neuro-Gastroenterology & Nutrition group, Toulouse, France
| | - Michael C. Wu
- Department of Biostatistics, Gillings School of Global Public Health, the University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jennica P. Siddle
- Division of Gastroenterology and Hepatology, Department of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lionel Bueno
- INRA, UMR1331 Toxalim, Neuro-Gastroenterology & Nutrition group, Toulouse, France
| | - Yehuda Ringel
- Division of Gastroenterology and Hepatology, Department of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| |
Collapse
|
76
|
Ringel Y, Maharshak N. Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2013; 305:G529-41. [PMID: 23886861 PMCID: PMC3798736 DOI: 10.1152/ajpgi.00207.2012] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/17/2013] [Indexed: 02/08/2023]
Abstract
The pathophysiology of irritable bowel syndrome (IBS) is believed to involve alterations in the brain-gut axis; however, the etiological triggers and mechanisms by which these changes lead to symptoms of IBS remain poorly understood. Although IBS is often considered a condition without an identified "organic" etiology, emerging evidence suggests that alterations in the gastrointestinal microbiota and altered immune function may play a role in the pathogenesis of the disorder. These recent data suggest a plausible model in which changes in the intestinal microbiota and activation of the enteric immune system may impinge upon the brain-gut axis, causing the alterations in gastrointestinal function and the clinical symptoms observed in patients with IBS. This review summarizes the current evidence for altered intestinal microbiota and immune function in IBS. It discusses the potential etiological role of these factors, suggests an updated conceptual model for the pathogenesis of the disorder, and identifies areas for future research.
Collapse
Affiliation(s)
- Yehuda Ringel
- Division of Gastroenterology and Hepatology, Univ. of North Carolina at Chapel Hill School of Medicine, 4107 BioInformatics Bldg., CB# 7080, 130 Mason Farm Rd., Chapel Hill, NC 27599-7080.
| | | |
Collapse
|
77
|
The role of calprotectin in pediatric disease. BIOMED RESEARCH INTERNATIONAL 2013; 2013:542363. [PMID: 24175291 PMCID: PMC3794633 DOI: 10.1155/2013/542363] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/06/2013] [Accepted: 08/26/2013] [Indexed: 12/12/2022]
Abstract
Calprotectin (CP) is a calcium- and zinc-binding protein of the S100 family expressed mainly by neutrophils with important extracellular activity. The aim of the current review is to summarize the latest findings concerning the role of CP in a diverse range of inflammatory and noninflammatory conditions among children. Increasing evidence suggests the implication of CP in the diagnosis, followup, assessment of relapses, and response to treatment in pediatric pathological conditions, such as inflammatory bowel disease, necrotizing enterocolitis, celiac disease, intestinal cystic fibrosis, acute appendicitis, juvenile idiopathic arthritis, Kawasaki disease, polymyositis-dermatomyositis, glomerulonephritis, IgA nephropathy, malaria, HIV infection, hyperzincemia and hypercalprotectinemia, and cancer. Further studies are required to provide insights into the actual role of CP in these pathological processes in pediatrics.
Collapse
|
78
|
Scalera A, Di Minno MND, Tarantino G. What does irritable bowel syndrome share with non-alcoholic fatty liver disease? World J Gastroenterol 2013; 19:5402-5420. [PMID: 24023483 PMCID: PMC3761093 DOI: 10.3748/wjg.v19.i33.5402] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/25/2013] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and irritable bowel syndrome (IBS) are two very common diseases in the general population. To date, there are no studies that highlight a direct link between NAFLD and IBS, but some recent reports have found an interesting correlation between obesity and IBS. A systematic PubMed database search was conducted highlighting that common mechanisms are involved in many of the local and systemic manifestations of NAFLD, leading to an increased cardiovascular risk, and IBS, leading to microbial dysbiosis, impaired intestinal barrier and altered intestinal motility. It is not known when considering local and systemic inflammation/immune system activation, which one has greater importance in NAFLD and IBS pathogenesis. Also, the nervous system is implicated. In fact, inflammation participates in the development of mood disorders, such as anxiety and depression, characteristics of obesity and consequently of NAFLD and, on the other hand, in intestinal hypersensitivity and dysmotility.
Collapse
|
79
|
Luminal cysteine-proteases degrade colonic tight junction structure and are responsible for abdominal pain in constipation-predominant IBS. Am J Gastroenterol 2013; 108:1322-31. [PMID: 23711626 DOI: 10.1038/ajg.2013.152] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/22/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Luminal serine-proteases lead to increased colonic paracellular permeability and visceral hypersensitivity in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Other proteases, namely cysteine-proteases (CPs), increase airway permeability by digesting epithelial tight junction proteins. In this study, we focused on constipation-predominant IBS (IBS-C) and we aimed to (i) evaluate CP levels in two cohorts of IBS patients, (ii) test if IBS-C fecal supernatant (FSN) affects permeability, and visceral sensitivity after repeated administrations in mice, and (iii) evaluate occludin expression in IBS-C colonic biopsies. METHODS Fecal CP activity was determined using selective substrate and inhibitor (E64). The effect of papain, as positive control, and IBS-C FSN administrations were evaluated on colonic paracellular permeability and mucosal occludin levels in mice and T84 monolayers. Occludin protein levels were evaluated in IBS-C colonic biopsies. Sensitivity to colorectal distension (CRD) was measured after repeated administrations of IBS-C FSN. RESULTS We found in a subset of IBS-C patients an enhanced fecal CP activity, in comparison with healthy controls and IBS-D patients. CP activity levels positively correlated with disease severity and abdominal pain scoring. This association was confirmed by receiver operating characteristic curve analysis. In mice, repeated application of IBS-C FSN into colon triggered increased permeability, linked to the enzymatic degradation of occludin, and was associated with enhanced visceral sensitivity to CRD. Finally, occludin levels were found decreased in colonic biopsies from IBS-C patients, and IBS-C FSNs were able to degrade recombinant human occludin in vitro. All these effects were abolished by preincubation of IBS-C FSN with a CP inhibitor, E64. CONCLUSIONS These data suggest that luminal CPs may represent a new factor contributing to the genesis of symptoms in IBS.
Collapse
|
80
|
Sun Y, Zhang M, Chen CC, Gillilland M, Sun X, El-Zaatari M, Huffnagle GB, Young VB, Zhang J, Hong SC, Chang YM, Gumucio DL, Owyang C, Kao JY. Stress-induced corticotropin-releasing hormone-mediated NLRP6 inflammasome inhibition and transmissible enteritis in mice. Gastroenterology 2013; 144:1478-87, 1487.e1-8. [PMID: 23470617 PMCID: PMC3777426 DOI: 10.1053/j.gastro.2013.02.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 02/23/2013] [Accepted: 02/27/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Stress alters brain-gut interactions and could exacerbate intestinal disorders, including irritable bowel syndrome. Alterations in the intestinal microbiota have been associated with irritable bowel syndrome. Maintenance of healthy microbiota requires nucleotide-binding oligomerization domain protein-like receptors, pyrin-domain containing (NLRP)-6 inflammasomes. We investigated the involvement of NLRP6 in water-avoidance stress (WAS)-induced intestinal disorders in mice. METHODS B57BL6 mice were subjected to WAS for 1 hour each day for 10 days; body weights and intestinal inflammation and permeability were analyzed. We investigated signaling via the NLRP3 and NLRP6 inflammasomes, and the role of corticotropin-releasing hormone (CRH) in WAS-associated inflammation and NLRP6 inhibition. Mice that were not exposed to stress were co-housed with mice subjected to WAS to determine the effects of WAS-induced dysbiosis, measured by sequencing bacterial 16S ribosomal RNA. We also assessed the effects of a peroxisome proliferator-activated receptor-γ agonist and probiotics. RESULTS WAS-induced small-bowel inflammation (enteritis) was associated with inhibition of NLRP6, but not NLRP3, and was prevented by a peroxisome proliferator-activated receptor-γ agonist, which induced epithelial expression of NLRP6. CRH was released during WAS and inhibited NLRP6 expression. WAS induced alterations in the gut microbiota of mice; co-housed nonstressed mice developed enteritis associated with increased CRH and decreased levels of NLRP6. Probiotic therapy reduced intestinal inflammation in mice with WAS-induced enteritis. CONCLUSIONS Exposure of mice to stress inhibits NLRP6 and alters the composition of the gut microbiota, leading to intestinal inflammation. These findings might explain the benefits of probiotics for patients with stress-associated gastrointestinal disorders.
Collapse
Affiliation(s)
- Yundong Sun
- Department of Microbiology, Shandong University School of Medicine, Jinan, Shandong, China
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Min Zhang
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Chun-Chia Chen
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National, Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Merritt Gillilland
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Xia Sun
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
- Institue of Pharmacology, Shandong University School of Medicine, Jinan, Shandong, China
| | - Mohamad El-Zaatari
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gary B. Huffnagle
- Division of Pulmonary and Critical Care, University of Michigan Medical School, Ann Arbor, Michigan
| | - Vincent B. Young
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jiajie Zhang
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
- Zhengzhou Maternal and Child Health Hospital, Zhengzhou, China
| | - Soon-Cheol Hong
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Yu-Ming Chang
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Deborah L. Gumucio
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Chung Owyang
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| | - John Y. Kao
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
81
|
Li X, Kan EM, Lu J, Cao Y, Wong RK, Keshavarzian A, Wilder-Smith CH. Combat-training increases intestinal permeability, immune activation and gastrointestinal symptoms in soldiers. Aliment Pharmacol Ther 2013; 37:799-809. [PMID: 23432460 DOI: 10.1111/apt.12269] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 07/30/2012] [Accepted: 02/07/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are common in soldiers in combat or high-pressure operational situations and often lead to compromised performance. Underlying mechanisms are unclear, but neuroendocrine dysregulation, immune activation and increased intestinal permeability may be involved in stress-related GI dysfunction. AIM To study the effects of prolonged, intense, mixed psychological and physical stress on intestinal permeability, systemic inflammatory and stress markers in soldiers during high-intensity combat-training. METHODS In 37 male army medical rapid response troops, GI symptoms, stress markers, segmental intestinal permeability using the 4-sugar test (sucrose, lactulose, mannitol and sucralose) and immune activation were assessed during the 4th week of an intense combat-training and a rest period. RESULTS Combat-training elicited higher stress, anxiety and depression scores (all P < 0.01) as well as greater incidence and severity of GI symptoms [irritable bowel syndrome symptom severity score (IBS-SSS), P < 0.05] compared with rest. The IBS-SSS correlated with depression (r = 0.41, P < 0.01) and stress (r = 0.40, P < 0.01) ratings. Serum levels of cortisol, interleukin-6, and tumour necrosis factor-α, and segmental GI permeability increased during combat-training compared with rest (all P < 0.05). The lactulose:mannitol ratio was higher in soldiers with GI symptoms (IBS-SSS ≥75) during combat-training than those without (IBS-SSS <75) (P < 0.05). CONCLUSIONS Prolonged combat-training not only induces the expected increases in stress, anxiety and depression, but also GI symptoms, pro-inflammatory immune activation and increased intestinal permeability. Identification of subgroups of individuals at high-risk of GI compromise and of long-term deleterious effects of operational stress as well as the development of protective measures will be the focus of future studies.
Collapse
Affiliation(s)
- X Li
- Neurogastroenterology Research Unit, Department of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | | |
Collapse
|
82
|
Del Valle-Pinero AY, Van Deventer HE, Fourie NH, Martino AC, Patel NS, Remaley AT, Henderson WA. Gastrointestinal permeability in patients with irritable bowel syndrome assessed using a four probe permeability solution. Clin Chim Acta 2013; 418:97-101. [PMID: 23328210 PMCID: PMC3594104 DOI: 10.1016/j.cca.2012.12.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/31/2012] [Accepted: 12/31/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Abnormal gastrointestinal permeability has been linked to irritable bowel syndrome (IBS). The lactulose-to-mannitol ratio is traditionally used to assess small intestine permeability while sucralose and sucrose are used to assess colonic and gastric permeability respectively. We used a single 4-probe test solution to assess permeability throughout the gastrointestinal tract in IBS patients and healthy controls by measuring the recovery of the probes in urine after ingestion using a modified liquid chromatography mass spectrometry protocol. METHODS Fasting participants (N=59) drank a permeability test solution (100ml: sucralose, sucrose, mannitol, and lactulose). Urine was collected over a 5-h period and kept frozen until analysis. Urinary sugar concentrations were measured using a liquid chromatography/triple quadruple mass spectrometer. RESULTS Colonic permeability was significantly lower in IBS patients when compared to healthy controls (p=0.011). Gastric and small intestinal permeability did not significantly differ between the groups. CONCLUSIONS The study demonstrates the clinical potential of this non-invasive method for assessing alterations in gastrointestinal permeability in patients with IBS.
Collapse
Affiliation(s)
| | - Hendrick E. Van Deventer
- Department of Laboratory Medicine, NIH, DHHS, Bethesda, MD
- Warren Grant Magnuson Clinical Center, NIH, DHHS, Bethesda, MD
| | - Nicolaas H. Fourie
- Biobehavioral Branch, Intramural Research Program, NINR, NIH, DHHS, Bethesda, MD
| | - Angela C. Martino
- Biobehavioral Branch, Intramural Research Program, NINR, NIH, DHHS, Bethesda, MD
| | - Nayan S. Patel
- Biobehavioral Branch, Intramural Research Program, NINR, NIH, DHHS, Bethesda, MD
| | - Alan T. Remaley
- Department of Laboratory Medicine, NIH, DHHS, Bethesda, MD
- Warren Grant Magnuson Clinical Center, NIH, DHHS, Bethesda, MD
| | - Wendy A. Henderson
- Biobehavioral Branch, Intramural Research Program, NINR, NIH, DHHS, Bethesda, MD
| |
Collapse
|
83
|
Functional abdominal pain in childhood: background studies and recent research trends. Pain Res Manag 2013; 17:413-7. [PMID: 23248815 DOI: 10.1155/2012/960104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors' research program. Specific areas discussed based on work within the authors' group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research.
Collapse
|
84
|
Hildebrand F, Nguyen TLA, Brinkman B, Yunta RG, Cauwe B, Vandenabeele P, Liston A, Raes J. Inflammation-associated enterotypes, host genotype, cage and inter-individual effects drive gut microbiota variation in common laboratory mice. Genome Biol 2013; 14:R4. [PMID: 23347395 PMCID: PMC4053703 DOI: 10.1186/gb-2013-14-1-r4] [Citation(s) in RCA: 335] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/08/2013] [Accepted: 01/24/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Murine models are a crucial component of gut microbiome research. Unfortunately, a multitude of genetic backgrounds and experimental setups, together with inter-individual variation, complicates cross-study comparisons and a global understanding of the mouse microbiota landscape. Here, we investigate the variability of the healthy mouse microbiota of five common lab mouse strains using 16S rDNA pyrosequencing. RESULTS We find initial evidence for richness-driven, strain-independent murine enterotypes that show a striking resemblance to those in human, and which associate with calprotectin levels, a marker for intestinal inflammation. After enterotype stratification, we find that genetic, caging and inter-individual variation contribute on average 19%, 31.7% and 45.5%, respectively, to the variance in the murine gut microbiota composition. Genetic distance correlates positively to microbiota distance, so that genetically similar strains have more similar microbiota than genetically distant ones. Specific mouse strains are enriched for specific operational taxonomic units and taxonomic groups, while the 'cage effect' can occur across mouse strain boundaries and is mainly driven by Helicobacter infections. CONCLUSIONS The detection of enterotypes suggests a common ecological cause, possibly low-grade inflammation that might drive differences among gut microbiota composition in mammals. Furthermore, the observed environmental and genetic effects have important consequences for experimental design in mouse microbiome research.
Collapse
Affiliation(s)
- Falk Hildebrand
- Department of Structural Biology, VIB, Pleinlaan 2, 1050 Brussels, Belgium
- Department of Bioscience Engineering, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Thi Loan Anh Nguyen
- Department of Structural Biology, VIB, Pleinlaan 2, 1050 Brussels, Belgium
- Department of Bioscience Engineering, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- Autoimmune Genetics Laboratory, VIB, Herestraat 49, 3000 Leuven, Belgium
- Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Brigitta Brinkman
- Department for Molecular Biomedical Research, VIB, Technologiepark Zwijnaarde 927, 9052 Ghent, Belgium
- Department for Molecular Biomedical Research, GhentUniversity, Technologiepark Zwijnaarde 927, 9052 Ghent, Belgium
| | - Roberto Garcia Yunta
- Department of Structural Biology, VIB, Pleinlaan 2, 1050 Brussels, Belgium
- Department of Bioscience Engineering, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Benedicte Cauwe
- Autoimmune Genetics Laboratory, VIB, Herestraat 49, 3000 Leuven, Belgium
- Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Peter Vandenabeele
- Department for Molecular Biomedical Research, VIB, Technologiepark Zwijnaarde 927, 9052 Ghent, Belgium
- Department for Molecular Biomedical Research, GhentUniversity, Technologiepark Zwijnaarde 927, 9052 Ghent, Belgium
| | - Adrian Liston
- Autoimmune Genetics Laboratory, VIB, Herestraat 49, 3000 Leuven, Belgium
- Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jeroen Raes
- Department of Structural Biology, VIB, Pleinlaan 2, 1050 Brussels, Belgium
- Department of Bioscience Engineering, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| |
Collapse
|
85
|
Detection of low-concentration host mRNA transcripts in Malawian children at risk for environmental enteropathy. J Pediatr Gastroenterol Nutr 2013; 56:66-71. [PMID: 22832511 DOI: 10.1097/mpg.0b013e31826a107a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Transcriptomic analysis of fecal samples is an emerging method for the diagnosis of gastrointestinal pathology because it is noninvasive and requires minute volumes of analyte; however, detection of mRNA in low copy numbers in human stool is challenging. Our objective was to develop a method for detecting human mRNA suggestive of environmental enteropathy (EE) in feces. METHODS Stool samples from 70 Malawian children, 34 without EE and 36 with EE, as defined by dual sugar absorption, were used to develop the methodology for mRNA detection. Multiple RNA isolation techniques and polymerase chain reaction formats were tested to detect 38 potential mRNA biomarkers suggestive of EE, and the results compared. RESULTS RNA isolation using magnetic bead extraction best recovered host mRNA in stool, and digital droplet polymerase chain reaction was the most sensitive format to detect low copy numbers of mRNA. In all of the 70 samples, >20 copies of glyceraldehyde-3-phosphate dehydrogenase/200 mg of stool were detected. Copy numbers of potential biomarkers were normalized to glyceraldehyde-3-phosphate dehydrogenase, to account for interspecimen differences in concentration of human mRNA. Of the 38 transcripts chosen for initial evaluation, 24 had copy numbers >10 in all of the samples tested. Of the 6 potential markers measured in all of the 70 samples, REG4 best differentiated children with and without EE. CONCLUSIONS A reproducible and reliable method to quantify human mRNA in stool present in low copy numbers has been developed, and may prove useful in investigations of EE and possibly other inflammatory gut conditions.
Collapse
|
86
|
Abstract
BACKGROUND Children with Crohn's disease (CD) may report abdominal pain despite clinical remission, suggesting that functional abdominal pain (FAP) may be playing a role. The aim of this study was to explore the presence and impact of FAP in children with CD in remission. METHODS Children, aged 9 to 17 years, with CD were enrolled. Demographic information, the Pediatric Crohn's Disease Activity Index, and the Children's Depression Inventory were obtained. Disease remission was defined by physician global assessment, normal laboratories findings, absence of 3 or more stools a day, nocturnal stooling, bloody diarrhea, concurrent steroid therapy, strictures, or disease flare within 6 months. FAP was defined as patients with abdominal pain and CD remission. Rates of depression (Children's Depression Inventory >9) were compared. RESULTS Of 307 children, 139 reported abdominal pain. Of this group, 18 of 139 (13%) children met the criteria for FAP. Despite clinical remission, 8 of 18 patients with CD having FAP were classified with active disease by Pediatric Crohn's Disease Activity Index. These patients had a higher rate of depression than patients with CD in remission with no abdominal pain (55.6% versus 29.9%; P = 0.03), similar to patients with abdominal pain from active CD (55.6% versus 44.8%; P = 0.62). CONCLUSIONS A proportion of children with CD in remission have FAP. These children are at significant risk of depression. Future studies are needed to determine whether depression contributes to functional pain development or if pain itself leads to depression. Especially given that functional pain may exaggerate disease activity, clinicians caring for children with CD and FAP should consider evaluating for depressive disorders before escalating therapy.
Collapse
|
87
|
Matricon J, Meleine M, Gelot A, Piche T, Dapoigny M, Muller E, Ardid D. Review article: Associations between immune activation, intestinal permeability and the irritable bowel syndrome. Aliment Pharmacol Ther 2012; 36:1009-31. [PMID: 23066886 DOI: 10.1111/apt.12080] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 09/18/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS), one of the most common gastrointestinal disorders, markedly impairing patients' quality of life. Drug development for IBS treatment has been hampered by the lack of understanding of IBS aetiology. In recent years, numerous data have emerged that suggest the involvement of immune activation in IBS, at least in a subset of patients. AIM To determine whether immune activation and intestinal permeabilisation are more frequently observed in IBS patients compared with healthy controls. METHODS The scientific bibliography was searched using the following keywords: irritable bowel syndrome, inflammation, immune activation, permeabilisation, intestine, assay, histology and human. The retrieved studies, including blood, faecal and histological studies, were analysed to provide a comprehensive and structured overview of the available data including the type of assay, type of inflammatory marker investigated or intestinal segment studied. RESULTS Immune activation was more frequently observed in IBS patients than in healthy controls. An increase in the number of mast cells and lymphocytes, an alteration in cytokine levels and intestinal permeabilisation were reported in IBS patients. No consistent changes in the numbers of B cells or enterochromaffin cells or in mucosal serotonin production were demonstrated. CONCLUSIONS The changes observed were modest and often heterogeneous among the studied population. Only appropriate interventions improving irritable bowel syndrome symptoms could highlight and confirm the role of immune activation in this pathophysiology.
Collapse
Affiliation(s)
- J Matricon
- Clermont Université, Université d'Auvergne, NEURO-DOL, Clermont-Ferrand, France; Inserm, Clermont-Ferrand, France.
| | | | | | | | | | | | | |
Collapse
|
88
|
Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| |
Collapse
|
89
|
Camilleri M, Lasch K, Zhou W. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2012; 303:G775-85. [PMID: 22837345 DOI: 10.1152/ajpgi.00155.2012] [Citation(s) in RCA: 260] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal ailments among those seeking health care for gastrointestinal disorders. Despite its prevalence, IBS pathophysiology is still not completely understood. Continued elucidation of IBS etiological mechanisms will lead to a greater appreciation of possible therapeutic targets. In the past decade, there has been increasing focus on the possible connection between increased intestinal mucosal permeability, inflammation, and visceral hypersensitivity. Increased permeability in subsets of IBS patients has been observed and the possible mechanisms underlying this defect are just beginning to be understood. The objectives of this review are to summarize the role of the healthy intestinal epithelium as a barrier between the lumen and the rest of the body with a focus on tight junctions; to examine the lines of evidence that suggest that different triggers lead to increased intestinal mucosal permeability and disruption of tight junctions in IBS patients; and to explore how this increased permeability may elicit immune responses that affect afferent nerves, resulting in the pain associated with IBS.
Collapse
Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research, College of Medicine, Mayo Clinic, Charlton 8-110, 200 First St. S.W., Rochester, MN 55905, USA.
| | | | | |
Collapse
|
90
|
CAMILLERI M, MADSEN K, SPILLER R, VAN MEERVELD BG, VERNE G, Verne GN. Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterol Motil 2012; 24:503-12. [PMID: 22583600 PMCID: PMC5595063 DOI: 10.1111/j.1365-2982.2012.01921.x] [Citation(s) in RCA: 552] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Defects in intestinal barrier function are associated with diseases of the gastrointestinal (GI) tract. There is growing evidence that increases in intestinal permeability plays a pathogenic role in diseases, such as inflammatory bowel disease (IBD) and celiac disease, and functional bowel disorders, such as irritable bowel syndrome (IBS). This review takes a unique translational approach to discuss the physiological and pathophysiological mechanisms involved in the regulation of intestinal barrier function in IBS. The review summarizes the components of the intestinal barrier including the tight junction complex within the epithelium, and the methods used to assess gut permeability both in vitro and in vivo. Throughout the review, the authors have attempted to critically review the latest research from both experimental animal models and human studies to appraise whether intestinal barrier dysfunction is a primary cause of functional GI disorders, such as IBS.…
Collapse
Affiliation(s)
- M. CAMILLERI
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA
| | - K. MADSEN
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - R. SPILLER
- NIHR Biomedical Research Unit in the Nottingham Digestive Diseases Centre University Hospital, Nottingham, UK
| | - B G. VAN MEERVELD
- Department of Physiology, Oklahoma Center for Neuroscience, VA Medical Center, University of Oklahoma Health Sciences Center, OK, USA
| | - G.N. VERNE
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch Galveston, TX, USA
| | | |
Collapse
|
91
|
Madrid AM, Landskron G, Klapp G, Reyes A, Pizarro C, Defilippi C. Lactulose hydrogen breath test and functional symptoms in pediatric patients. Dig Dis Sci 2012; 57:1330-5. [PMID: 22297652 DOI: 10.1007/s10620-012-2032-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 01/04/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H(2) breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria. METHODS Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H(2) concentration of 20 ppm over basal. RESULTS There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p\0.05. In 39% of patients, rise of H(2) occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p\0.05). Symptoms were unrelated to time to 20-ppm change. CONCLUSIONS An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.
Collapse
Affiliation(s)
- Ana María Madrid
- Laboratory of Motility and Functional Digestive Disorders, GI Section, Medicine Department, University Hospital, University of Chile, Santos Dumont 999, Santiago, Chile.
| | | | | | | | | | | |
Collapse
|
92
|
Fiskerstrand T, Arshad N, Haukanes BI, Tronstad RR, Pham KDC, Johansson S, Håvik B, Tønder SL, Levy SE, Brackman D, Boman H, Biswas KH, Apold J, Hovdenak N, Visweswariah SS, Knappskog PM. Familial diarrhea syndrome caused by an activating GUCY2C mutation. N Engl J Med 2012; 366:1586-95. [PMID: 22436048 DOI: 10.1056/nejmoa1110132] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Familial diarrhea disorders are, in most cases, severe and caused by recessive mutations. We describe the cause of a novel dominant disease in 32 members of a Norwegian family. The affected members have chronic diarrhea that is of early onset, is relatively mild, and is associated with increased susceptibility to inflammatory bowel disease, small-bowel obstruction, and esophagitis. METHODS We used linkage analysis, based on arrays with single-nucleotide polymorphisms, to identify a candidate region on chromosome 12 and then sequenced GUCY2C, encoding guanylate cyclase C (GC-C), an intestinal receptor for bacterial heat-stable enterotoxins. We performed exome sequencing of the entire candidate region from three affected family members, to exclude the possibility that mutations in genes other than GUCY2C could cause or contribute to susceptibility to the disease. We carried out functional studies of mutant GC-C using HEK293T cells. RESULTS We identified a heterozygous missense mutation (c.2519G→T) in GUCY2C in all affected family members and observed no other rare variants in the exons of genes in the candidate region. Exposure of the mutant receptor to its ligands resulted in markedly increased production of cyclic guanosine monophosphate (cGMP). This may cause hyperactivation of the cystic fibrosis transmembrane regulator (CFTR), leading to increased chloride and water secretion from the enterocytes, and may thus explain the chronic diarrhea in the affected family members. CONCLUSIONS Increased GC-C signaling disturbs normal bowel function and appears to have a proinflammatory effect, either through increased chloride secretion or additional effects of elevated cellular cGMP. Further investigation of the relevance of genetic variants affecting the GC-C-CFTR pathway to conditions such as Crohn's disease is warranted. (Funded by Helse Vest [Western Norway Regional Health Authority] and the Department of Science and Technology, Government of India.).
Collapse
Affiliation(s)
- Torunn Fiskerstrand
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
93
|
Abstract
The present review describes advances in understanding the mechanisms and provide an update of present and promising therapy directed at the gut or the brain in the treatment of irritable bowel syndrome (IBS). The diagnosis of IBS typically is based on identification of symptoms, such as the Rome III criteria for IBS in adults and children. The criteria are similar in children and adults. The focus of the present review is the bowel dysfunction associated with IBS.
Collapse
|
94
|
DEL VALLE-PINERO AY, MARTINO AC, TAYLOR TJ, MAJORS BL, PATEL NS, HEITKEMPER MM, HENDERSON WA. Pro-inflammatory chemokine C-C motif ligand 16 (CCL-16) dysregulation in irritable bowel syndrome (IBS): a pilot study. Neurogastroenterol Motil 2011; 23:1092-7. [PMID: 21951809 PMCID: PMC3557463 DOI: 10.1111/j.1365-2982.2011.01792.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a serious health problem that affects an estimated 10-15% of people worldwide and has economic consequences in the United States of over $30 billion annually. In the US, IBS affects all races and both sexes, with more females than males (2:1) reporting symptoms consistent with IBS. Although the etiology of this functional gastrointestinal disorder is unknown, literature suggests that a subclinical inflammatory component has a role in the etiologic mechanisms underlying IBS. The aim of this study was to evaluate the gene expression of inflammatory biomarkers in patients with and without IBS and among different IBS phenotypes. METHODS Irritable bowel syndrome patients (n=12) that met Rome III Criteria for IBS longer than 6months were compared with healthy matched controls (n=12). Peripheral whole blood from fasting participants was collected and RNA was extracted. The expression of 96 inflammatory genes was then analyzed using a custom quantitative real-time PCR array. KEY RESULTS CCL-16 gene expression was upregulated by 7.46-fold in IBS patients when compared with controls. CCL-16 was overexpressed by over 130-fold in IBS-constipation patients when compared with both controls and IBS-diarrhea patients. CONCLUSIONS & INFERENCES These results further suggest a subclinical inflammatory component underlying IBS. To better understand the phenotypic differences in IBS it is important to broaden the study of these inflammatory and other biomarkers.
Collapse
Affiliation(s)
- A. Y. DEL VALLE-PINERO
- Biobehavioral Branch, Intramural Research Program, National Institute of Nursing Research, NIH, DHHS, Bethesda, MD, USA
| | - A. C. MARTINO
- Biobehavioral Branch, Intramural Research Program, National Institute of Nursing Research, NIH, DHHS, Bethesda, MD, USA
| | - T. J. TAYLOR
- Biobehavioral Branch, Intramural Research Program, National Institute of Nursing Research, NIH, DHHS, Bethesda, MD, USA
| | - B. L. MAJORS
- Biobehavioral Branch, Intramural Research Program, National Institute of Nursing Research, NIH, DHHS, Bethesda, MD, USA
| | - N. S. PATEL
- Biobehavioral Branch, Intramural Research Program, National Institute of Nursing Research, NIH, DHHS, Bethesda, MD, USA
| | - M. M. HEITKEMPER
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - W. A. HENDERSON
- Biobehavioral Branch, Intramural Research Program, National Institute of Nursing Research, NIH, DHHS, Bethesda, MD, USA
| |
Collapse
|
95
|
Irritables Kolon bei Kindern. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
96
|
Saulnier DM, Riehle K, Mistretta TA, Diaz MA, Mandal D, Raza S, Weidler EM, Qin X, Coarfa C, Milosavljevic A, Petrosino JF, Highlander S, Gibbs R, Lynch SV, Shulman RJ, Versalovic J. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. Gastroenterology 2011; 141:1782-91. [PMID: 21741921 PMCID: PMC3417828 DOI: 10.1053/j.gastro.2011.06.072] [Citation(s) in RCA: 479] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 06/15/2011] [Accepted: 06/24/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The intestinal microbiomes of healthy children and pediatric patients with irritable bowel syndrome (IBS) are not well defined. Studies in adults have indicated that the gastrointestinal microbiota could be involved in IBS. METHODS We analyzed 71 samples from 22 children with IBS (pediatric Rome III criteria) and 22 healthy children, ages 7-12 years, by 16S ribosomal RNA gene sequencing, with an average of 54,287 reads/stool sample (average 454 read length = 503 bases). Data were analyzed using phylogenetic-based clustering (Unifrac), or an operational taxonomic unit (OTU) approach using a supervised machine learning tool (randomForest). Most samples were also hybridized to a microarray that can detect 8741 bacterial taxa (16S rRNA PhyloChip). RESULTS Microbiomes associated with pediatric IBS were characterized by a significantly greater percentage of the class γ-proteobacteria (0.07% vs 0.89% of total bacteria, respectively; P < .05); 1 prominent component of this group was Haemophilus parainfluenzae. Differences highlighted by 454 sequencing were confirmed by high-resolution PhyloChip analysis. Using supervised learning techniques, we were able to classify different subtypes of IBS with a success rate of 98.5%, using limited sets of discriminant bacterial species. A novel Ruminococcus-like microbe was associated with IBS, indicating the potential utility of microbe discovery for gastrointestinal disorders. A greater frequency of pain correlated with an increased abundance of several bacterial taxa from the genus Alistipes. CONCLUSIONS Using 16S metagenomics by PhyloChip DNA hybridization and deep 454 pyrosequencing, we associated specific microbiome signatures with pediatric IBS. These findings indicate the important association between gastrointestinal microbes and IBS in children; these approaches might be used in diagnosis of functional bowel disorders in pediatric patients.
Collapse
Affiliation(s)
- Delphine M. Saulnier
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX,NIZO, Ede, The Netherlands
| | - Kevin Riehle
- Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Bioinformatics Research Laboratory, Baylor College of Medicine, Houston, TX
| | - Toni-Ann Mistretta
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Maria-Alejandra Diaz
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Debasmita Mandal
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Sabeen Raza
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Children's Nutrition Research Center, Houston, TX
| | - Xiang Qin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Cristian Coarfa
- Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Bioinformatics Research Laboratory, Baylor College of Medicine, Houston, TX
| | - Aleksandar Milosavljevic
- Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Bioinformatics Research Laboratory, Baylor College of Medicine, Houston, TX
| | - Joseph F. Petrosino
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX,Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX
| | - Sarah Highlander
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Richard Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Susan V. Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Children's Nutrition Research Center, Houston, TX
| | - James Versalovic
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX,Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| |
Collapse
|
97
|
Rao AS, Camilleri M, Eckert DJ, Busciglio I, Burton DD, Ryks M, Wong BS, Lamsam J, Singh R, Zinsmeister AR. Urine sugars for in vivo gut permeability: validation and comparisons in irritable bowel syndrome-diarrhea and controls. Am J Physiol Gastrointest Liver Physiol 2011; 301:G919-28. [PMID: 21836056 PMCID: PMC3220318 DOI: 10.1152/ajpgi.00168.2011] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 08/07/2011] [Indexed: 01/31/2023]
Abstract
Mucosal barrier dysfunction contributes to gastrointestinal diseases. Our aims were to validate urine sugar excretion as an in vivo test of small bowel (SB) and colonic permeability and to compare permeability in patients with irritable bowel syndrome-diarrhea (IBS-D) to positive and negative controls. Oral lactulose (L) and mannitol (M) were administered with (99m)Tc-oral solution, (111)In-oral delayed-release capsule, or directly into the ascending colon (only in healthy controls). We compared L and M excretion in urine collections at specific times in 12 patients with IBS-D, 12 healthy controls, and 10 patients with inactive or treated ulcerative or microscopic colitis (UC/MC). Sugars were measured by high-performance liquid chromatography-tandem mass spectrometry. Primary endpoints were cumulative 0-2-h, 2-8-h, and 8-24-h urinary sugars. Radioisotopes in the colon at 2 h and 8 h were measured by scintigraphy. Kruskal-Wallis and Wilcoxon tests were used to assess the overall and pairwise associations, respectively, between group and urinary sugars. The liquid in the colon at 2 h and 8 h was as follows: health, 62 ± 9% and 89 ± 3%; IBS-D, 56 ± 11% and 90 ± 3%; and UC/MC, 35 ± 8% and 78 ± 6%, respectively. Liquid formulation was associated with higher M excretion compared with capsule formulation at 0-2 h (health P = 0.049; IBS-D P < 0.001) but not during 8-24 h. UC/MC was associated with increased urine L and M excretion compared with health (but not to IBS-D) at 8-24 h, not at 0-2 h. There were significant differences between IBS-D and health in urine M excretion at 0-2 h and 2-8 h and L excretion at 8-24 h. Urine sugars at 0-2 h and 8-24 h reflect SB and colonic permeability, respectively. IBS-D is associated with increased SB and colonic mucosal permeability.
Collapse
Affiliation(s)
- Archana S Rao
- Clinical Enteric Neuroscience Translational and Epidemiological Research, Division of Biomedical Statistics and Informatics, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
98
|
Chiou E, Nurko S. Functional abdominal pain and irritable bowel syndrome in children and adolescents. THERAPY (LONDON, ENGLAND : 2004) 2011; 8:315-331. [PMID: 21731470 PMCID: PMC3127202 DOI: 10.2217/thy.11.7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominal pain and are among the most commonly diagnosed medical problems in pediatrics. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Based on the biopsychosocial model of functional disease, the Rome III criteria have helped frame FAP and IBS in terms of being a positive diagnosis and not a diagnosis of exclusion. However, the lack of a single, proven intervention highlights the complex interplay of pathologic mechanisms likely involved in the development of childhood FAP and IBS and the need for a multidisciplinary, integrated approach. This article discusses the epidemiology, proposed mechanisms, clinical approach and therapeutic options for the management of FAP and IBS in children and adolescents.
Collapse
Affiliation(s)
- Eric Chiou
- Center for Motility & Functional Gastrointestinal Disorders, Children’s, Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA
| | - Samuel Nurko
- Center for Motility & Functional Gastrointestinal Disorders, Children’s, Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA
- Author for correspondence: Tel.: +1 617 355 6055,
| |
Collapse
|
99
|
Bufler P, Gross M, Uhlig HH. Recurrent abdominal pain in childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:295-304. [PMID: 21629513 PMCID: PMC3103980 DOI: 10.3238/arztebl.2011.0295] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/31/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic, recurrent abdominal pain is common among children and adolescents. It interferes with everyday life, causes absence from school, and leads to frequent medical consultations, often involving burdensome diagnostic testing and protracted attempts at treatment. METHOD Selective review of the literature. RESULTS Organic causes should be ruled out with a thorough medical history and physical examination and a small number of laboratory tests. The pediatric Rome III criteria include valid diagnostic criteria for functional abdominal pain in childhood. The available data imply that this condition is best treated with cognitive behavioral therapy, rather than with medications or dietary measures. CONCLUSION A systematic approach to chronic recurrent abdominal pain in children and adolescents is key to ruling out organic diseases while avoiding unnecessary tests and treatments.
Collapse
Affiliation(s)
- Philip Bufler
- Abteilung für Pädiatrische Gastroenterologie und Hepatologie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 München, Germany.
| | | | | |
Collapse
|
100
|
Decreased interleukin-10 secretion by peripheral blood mononuclear cells in children with irritable bowel syndrome. J Pediatr Gastroenterol Nutr 2011; 52:376-81. [PMID: 21407110 DOI: 10.1097/mpg.0b013e3181fd9816] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The aim of the present study was to evaluate proinflammatory and anti-inflammatory cytokine levels in children with irritable bowel syndrome (IBS). PATIENTS AND METHODS Thirty-five children with IBS (17 diarrhea-predominant, 7 constipation-predominant, and 11 mixed type) and 25 healthy children as healthy controls (HCs) were enrolled. All of the participants completed a questionnaire recording the duration, severity, and associated academic and social influences. Peripheral blood mononuclear cells were isolated and cultured for 24 hours with and without 1 or 5 ng/mL Escherichia coli lipopolysaccharide (LPS). Cytokine production including tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-10 was measured using enzyme-linked immunosorbent assays. RESULTS Children with IBS revealed lower baseline and significantly lower IL-10 levels after LPS stimulation compared with HCs (P = 0.001). Although not to a significant level, TNF-α and IL-6 levels were higher in children with IBS compared with HCs. The IL-10 levels in patients with IBS with strong pain intensity were lower both in baseline and under 1 ng/mL LPS stimulation. The levels became significantly lower under 5 ng/mL LPS stimulation compared with those experiencing mild and moderate pain intensity (P = 0.025). CONCLUSIONS Our study suggests that children with IBS tend to produce lower amounts of the anti-inflammatory cytokine IL-10 at baseline and after LPS stimulation, implying that defects in immune modulation may contribute to IBS in children.
Collapse
|