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Zubeldia-Varela E, Blanco-Pérez F, Barker-Tejeda TC, Rojo D, Villaseñor A, Islam J, Gonzalez-Menendez I, Laiño J, Krause M, Steigerwald H, Martella M, Quintanilla-Martinez L, Yu P, Barbas C, Vieths S, Nochi T, Barber D, Toda M, Pérez-Gordo M. The impact of high-IgE levels on metabolome and microbiome in experimental allergic enteritis. Allergy 2024. [PMID: 38932655 DOI: 10.1111/all.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/03/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The pathological mechanism of the gastrointestinal forms of food allergies is less understood in comparison to other clinical phenotypes, such as asthma and anaphylaxis Importantly, high-IgE levels are a poor prognostic factor in gastrointestinal allergies. METHODS This study investigated how high-IgE levels influence the development of intestinal inflammation and the metabolome in allergic enteritis (AE), using IgE knock-in (IgEki) mice expressing high levels of IgE. In addition, correlation of the altered metabolome with gut microbiome was analysed. RESULTS Ovalbumin-sensitized and egg-white diet-fed (OVA/EW) BALB/c WT mice developed moderate AE, whereas OVA/EW IgEki mice induced more aggravated intestinal inflammation with enhanced eosinophil accumulation. Untargeted metabolomics detected the increased levels of N-tau-methylhistamine and 2,3-butanediol, and reduced levels of butyric acid in faeces and/or sera of OVA/EW IgEki mice, which was accompanied with reduced Clostridium and increased Lactobacillus at the genus level. Non-sensitized and egg-white diet-fed (NC/EW) WT mice did not exhibit any signs of AE, whereas NC/EW IgEki mice developed marginal degrees of AE. Compared to NC/EW WT mice, enhanced levels of lysophospholipids, sphinganine and sphingosine were detected in serum and faecal samples of NC/EW IgEki mice. In addition, several associations of altered metabolome with gut microbiome-for example Akkermansia with lysophosphatidylserine-were detected. CONCLUSIONS Our results suggest that high-IgE levels alter intestinal and systemic levels of endogenous and microbiota-associated metabolites in experimental AE. This study contributes to deepening the knowledge of molecular mechanisms for the development of AE and provides clues to advance diagnostic and therapeutic strategies of allergic diseases.
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Affiliation(s)
- Elisa Zubeldia-Varela
- Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
- Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Frank Blanco-Pérez
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Tomás Clive Barker-Tejeda
- Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
- Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - David Rojo
- Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Alma Villaseñor
- Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
- Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Jahidul Islam
- Laboratory of Animal Functional Morphology, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Irene Gonzalez-Menendez
- Cluster of Excellence iFIT (EXC 2180) 'Image Guided and Functionally Instructed Tumor Therapies', Tübingen, Germany
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tuebingen, Eberhard Karls University, Tübingen, Germany
| | - Jonathan Laiño
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Maren Krause
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Hanna Steigerwald
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Manuela Martella
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tuebingen, Eberhard Karls University, Tübingen, Germany
| | - Leticia Quintanilla-Martinez
- Cluster of Excellence iFIT (EXC 2180) 'Image Guided and Functionally Instructed Tumor Therapies', Tübingen, Germany
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tuebingen, Eberhard Karls University, Tübingen, Germany
| | - Philipp Yu
- Institute for Immunology, Philipps-Universität Marburg, Marburg, Germany
| | - Coral Barbas
- Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Stefan Vieths
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Tomonori Nochi
- Laboratory of Animal Functional Morphology, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Domingo Barber
- Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Masako Toda
- Molecular Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
- Laboratory of Food and Biomolecular Science, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan
| | - Marina Pérez-Gordo
- Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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Heßler N, Kordowski A, Sasse J, Ahlemann G, Schulz F, Schröder T, Exner A, Jablonski L, Jappe U, Bischoff SC, Grzegorzek M, König IR, Sina C. Study protocol to investigate the efficacy of confocal laser endomicroscopy-based selective single-elimination diet over standard fivefold elimination diet in patients with endomicroscopically proven food intolerance: app-assisted, monocentric, double-blind, randomised and controlled trial in Germany. BMJ Open 2023; 13:e072024. [PMID: 37918930 PMCID: PMC10626857 DOI: 10.1136/bmjopen-2023-072024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Imprecise nutritional recommendations due to a lack of diagnostic test accuracy are a frequent problem for individuals with adverse reactions to foods but no precise diagnosis. Consequently, patients follow very broad and strict elimination diets to avoid uncontrolled symptoms such as diarrhoea and abdominal pain. Dietary limitations and the uncertainty of developing gastrointestinal symptoms after the inadvertent ingestion of food have been demonstrated to reduce the quality of life (QoL) of affected individuals and subsequently might increase the risk of malnutrition and intestinal dysbiosis. This trial aims to investigate the effects of a tailored diet based on the confocal laser endoscopy (CLE) examination result to limit the side effects of unspecific and broad elimination diets and to increase the patient's QoL. METHODS AND ANALYSIS The study is designed as a prospective, double-blind, monocentric, randomised and controlled trial conducted at the University Hospital of Schleswig-Holstein, Campus Lübeck, Germany. One hundred seventy-two patients with non-IgE-related food allergies and positive CLE results will be randomised to either a tailored diet or a standard fivefold elimination diet. The primary endpoints are the difference between the end and the start of the intervention in health-related QoL and the sum score of the severity of symptoms after 12 weeks. Key secondary endpoints are changes in the severity of symptoms, further QoL measurements, self-assessed state of health and number of days with a pathologically altered stool. Microbiome diversity and metabolome of stool, urine and blood will also be investigated. Safety endpoints are body composition, body mass index and adverse events. ETHICS AND DISSEMINATION The study protocol was accepted by the ethical committee of the University of Lübeck (AZ: 22-111) on 4 May2022. Results of the study will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00029323).
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Affiliation(s)
- Nicole Heßler
- Institute of Medical Biometry and Statistics (IMBS), University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Anna Kordowski
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and University of Lübeck, Lübeck, Germany
| | - Jill Sasse
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and University of Lübeck, Lübeck, Germany
| | - Greta Ahlemann
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and University of Lübeck, Lübeck, Germany
| | | | - Torsten Schröder
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and University of Lübeck, Lübeck, Germany
- Perfood GmbH, Research and Developement, Lübeck, Germany
| | - Anna Exner
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Lennart Jablonski
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - Stephan C Bischoff
- Department of Clinical Nutrition and Prevention, University of Hohenheim, Stuttgart, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics (IMBS), University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christian Sina
- Institute of Nutritional Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and University of Lübeck, Lübeck, Germany
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Raithel M, Bischoff SC. Allergisch bedingte Magen-Darm-Erkrankungen und Nahrungsmittelunverträglichkeiten. ALLERGO JOURNAL 2020; 29:40-44. [PMID: 33343098 PMCID: PMC7735185 DOI: 10.1007/s15007-020-2647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Raithel
- Malteser Waldkrankenhaus Erlangen, Rathsberger Str. 57, 91054 Erlangen, Germany
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Joo JY, Cho JM, Yoo IH, Yang HR. Eosinophilic gastroenteritis as a cause of non-Helicobacter pylori, non-gastrotoxic drug ulcers in children. BMC Gastroenterol 2020; 20:280. [PMID: 32819298 PMCID: PMC7439514 DOI: 10.1186/s12876-020-01416-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background While Helicobacter pylori (H. pylori) ulcers has declined recently, H. pylori-negative and/or gastrotoxic drug-negative peptic ulcers (HNGN-PU) has increased. This study aimed to analyze the etiology of peptic ulcers in children and the differences in clinical, laboratory, endoscopic, and histopathologic findings of peptic ulcers according to etiology, including eosinophilic gastroenteritis (EoGE). Methods In total, 255 children (157 boys and 98 girls) with peptic ulcers were recruited. The subjects were categorized into 5 groups according to the etiology of the ulcer: 1) H. pylori infection (n = 51); 2) gastrotoxic drugs (n = 18); 3) idiopathic (n = 144); 4) systemic disease (n = 23); 5) EoGE (n = 19). Clinical data were reviewed and analyzed retrospectively. Results Age at diagnosis, ulcer recurrence, atopic dermatitis history, white blood cell count, blood eosinophil count, platelet count, serum albumin level, iron level, erythrocyte sedimentation rate, and C-reactive protein level differed significantly among the 5 groups (all p < 0.05). Regarding endoscopic findings, multiple ulcers and gastric mucosal nodularity differed among the 5 groups (all p < 0.05). When comparing the EoGE ulcer group with the others, EoGE group revealed older ages (p = 0.022), higher rates of ulcer recurrence (p = 0.018), atopic dermatitis history (p = 0.001), and both blood and tissue eosinophilia (both p = 0.001). Conclusions EoGE ulcers constituted 10.2% of HNGN-PU in pediatric patients. In children with HNGN-PU, peripheral eosinophilia, ulcer recurrence, and atopic dermatitis history might imply EoGE, necessitating thorough investigation of tissue eosinophils during endoscopic biopsy. Trial registration A total of 255 children was retrospectively registered between between July 2003 and April 2017.
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Affiliation(s)
- Jung Yeon Joo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Jin Min Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - In Hyuk Yoo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea. .,Seoul National University College of Medicine, Seoul, South Korea.
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Liang M, Liwen Z, Bingfang C, Yanbo D, Jianping C. Eosinophilic gastroenteritis with multiple serous membrane effusion as the first sign: a case report and literature review. J Int Med Res 2020; 48:300060520917274. [PMID: 32321384 PMCID: PMC7180310 DOI: 10.1177/0300060520917274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
Multiple serous membrane effusion (MSSE) as the first sign of eosinophilic gastroenteritis is extremely rare, and its clinical features and treatment methods have not been well described. The clinical characteristics, diagnosis, and treatment methods of MSSE in a 44-year-old woman were retrospectively reviewed. Laboratory testing revealed an elevated eosinophil count and serum immunoglobulin E level. The levels of all tumor markers were normal, but the CA125 level in serum and ascitic fluid was significantly increased. Ultrasonography showed a large amount of ascites and a moderate amount of pleural effusion. Echocardiography showed a small amount of pericardial effusion. Chest and abdominal computed tomography showed gastrointestinal wall thickening. Moreover, eosinophilic infiltration was detected in duodenal and rectal biopsy samples that had been collected during endoscopic examination of the upper gastrointestinal system. The patient was treated with 30 mg of prednisolone, and seafood was excluded from her diet for 4 weeks. The prednisolone was tapered over 8 weeks and continued at 5 mg prednisolone daily thereafter. The MSSE and peripheral eosinophilia showed a dramatic response to the steroid treatment. This case indicates that we should be highly aware of MSSE as the first clinical manifestation of eosinophilic gastroenteritis.
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Affiliation(s)
- Ma Liang
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| | - Zhang Liwen
- Department of Pediatrics, The Second People’s Hospital of
Changzhou, Affiliate Hospital of NanJing Medical University, Changzhou, Jiangsu,
China
| | - Chen Bingfang
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| | - Ding Yanbo
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| | - Chen Jianping
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
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Lee M, Choi SY, Chung ML, Lee J, Sung M. A Rare Case of Eosinophilic Gastroenteritis in a Neonate with Fever. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ho SM, Lewis JD, Mayer EA, Bernstein CN, Plevy SE, Chuang E, Rappaport SM, Croitoru K, Korzenik JR, Krischer J, Hyams JS, Judson R, Kellis M, Jerrett M, Miller GW, Grant ML, Shtraizent N, Honig G, Hurtado-Lorenzo A, Wu GD. Challenges in IBD Research: Environmental Triggers. Inflamm Bowel Dis 2019; 25:S13-S23. [PMID: 31095702 PMCID: PMC6787673 DOI: 10.1093/ibd/izz076] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 02/07/2023]
Abstract
Environmental triggers is part of five focus areas of the Challenges in IBD research document, which also includes preclinical human IBD mechanisms, novel technologies, precision medicine and pragmatic clinical research. The Challenges in IBD research document provides a comprehensive overview of current gaps in inflammatory bowel diseases (IBD) research and delivers actionable approaches to address them. It is the result of a multidisciplinary input from scientists, clinicians, patients, and funders, and represents a valuable resource for patient centric research prioritization. In particular, the environmental triggers section is focused on the main research gaps in elucidating causality of environmental factors in IBD. Research gaps were identified in: 1) epidemiology of exposures; 2) identification of signatures of biological response to exposures; and 3) mechanisms of how environmental exposures drive IBD. To address these gaps, the implementation of longitudinal prospective studies to determine disease evolution and identify sub-clinical changes in response to exposures is proposed. This can help define critical windows of vulnerability and risk prediction. In addition, systems biology analysis and in silico modeling were proposed as approaches to integrate the IBD exposome for the identification of biological signatures of response to exposures, and to develop prediction models of the effects of environmental factors in driving disease activity and response to therapy. This research could lead to identification of biomarkers of exposures and new modalities for therapeutic intervention. Finally, hypothesis-driven mechanistic studies to understand gene-environment interactions and to validate causality of priority factors should be performed to determine how environment influences clinical outcomes.
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Affiliation(s)
| | - James D Lewis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emeran A Mayer
- University of California Los Angeles, Los Angeles, California
| | | | | | | | | | | | | | | | - Jeffrey S Hyams
- Connecticut Children’s Medical Center, Hartford, Connecticut
| | - Richard Judson
- United States Environmental Protection Agency, Washington, District of Columbia
| | - Manolis Kellis
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Michael Jerrett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Melanie L Grant
- Children’s National Health System, Washington, District of Columbia
| | | | - Gerard Honig
- Crohn’s & Colitis Foundation, New York, New York
| | - Andrés Hurtado-Lorenzo
- Crohn’s & Colitis Foundation, New York, New York,Address correspondence to: Andrés Hurtado-Lorenzo, PhD, 733 3rd Ave Suite 510, New York, NY USA 10017 ()
| | - Gary D Wu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE Pediatric colonic eosinophilia represents a confounding finding with a wide differential. It is often difficult to determine which children may progress to inflammatory bowel disease (IBD), which have an eosinophilic colitis (EC), and which may have no underlying pathology. There is little guidance for the practitioner on the approach to these patients. To define the clinical presentations of colonic eosinophilia and identify factors which may aid in diagnosis we reviewed patients with colonic eosinophilia and the clinicopathologic factors associated with their diagnoses. METHODS An 8-year retrospective chart review of children whose histopathology identified colonic eosinophilia (N = 72) compared to controls with normal biopsies (N = 35). RESULTS Patients with colonic eosinophilia had increased eosinophils/high-power field compared to controls (P < 0.001) and had 3 clinical phenotypes. Thirty-six percent had an inflammatory phenotype with elevated erythrocyte sedimentation rate (P < .0001), chronic inflammation on colonic biopsies (P < 0.001), and were diagnosed as having IBD. Thirty-seven percent were diagnosed as having EC, associated with male sex (P < 0.005) and peripheral eosinophilia (P = 0.041). Twenty-one percent had no significant colonic pathology. Forty-three percent of patients had >1 colonoscopy and 68% of these had change from initial diagnoses. CONCLUSIONS There are 3 main phenotypes of children with colonic eosinophilia. Signs of chronic systemic inflammation raise suspicion for IBD. Peripheral eosinophilia and male sex are associated with EC. A significant percent of children with colonic eosinophilia do not have colonic disease. Eosinophils/high-power field is not reliable to differentiate etiologies. Repeat colonoscopies may be required to reach final diagnoses.
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Díaz del Arco C, Taxonera C, Olivares D, Fernández Aceñero MJ. Eosinophilic colitis: Case series and literature review. Pathol Res Pract 2018; 214:100-104. [PMID: 29103770 DOI: 10.1016/j.prp.2017.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022]
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Manohar M, Verma AK, Upparahalli Venkateshaiah S, Goyal H, Mishra A. Food-Induced Acute Pancreatitis. Dig Dis Sci 2017; 62:3287-3297. [PMID: 29086330 PMCID: PMC5718054 DOI: 10.1007/s10620-017-4817-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/19/2017] [Indexed: 12/24/2022]
Abstract
Food allergy, a commonly increasing problem worldwide, defined as an adverse immune response to food. A variety of immune-related effector cells such as mast cells, eosinophils, neutrophils, and T cells are involved in food-related allergic responses categorized as IgE mediated, non-IgE mediated, and mixed (IgE and non-IgE) depending upon underlying immunological mechanisms. The dietary antigens mainly target the gastrointestinal tract including pancreas that gets inflamed due to food allergy and leads acute pancreatitis. Reports indicate several food proteins induce pancreatitis; however, detailed underlying mechanism of food-induced pancreatitis is unexplored. The aim of the review is to understand and update the current scenario of food-induced pancreatitis. A comprehensive literature search of relevant research articles has been performed through PubMed, and articles were chosen based on their relevance to food allergen-mediated pancreatitis. Several cases in the literature indicate that acute pancreatitis has been provoked after the consumption of mustard, milk, egg, banana, fish, and kiwi fruits. Food-induced pancreatitis is an ignored and unexplored area of research. The review highlights the significance of food in the development of pancreatitis and draws the attention of physicians and scientists to consider food allergies as a possible cause for initiation of pancreatitis pathogenesis.
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Affiliation(s)
- Murli Manohar
- Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorders Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Alok K Verma
- Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorders Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Sathisha Upparahalli Venkateshaiah
- Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorders Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, 707 Pine St., Macon, GA, 31201, USA
| | - Anil Mishra
- Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic Disorders Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
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Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017. Clin Gastroenterol Hepatol 2017; 15:1733-1741. [PMID: 28603057 DOI: 10.1016/j.cgh.2017.05.050] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although eosinophilic esophagitis (EoE) has been extensively studied, there have been few epidemiology studies of other eosinophilic gastrointestinal disorders (EGIDs). Using a large, population-based database, we investigated epidemiologic features of eosinophilic gastroenteritis (EoGE) and eosinophilic colitis (EoC) in the United State. METHODS We collected data from a commercial database (Explorys Inc, Cleveland, OH) that provided electronic health records from 26 major integrated U.S. healthcare systems from 1999 to March 2017. We identified a cohort of adult and pediatric patients with EoGE and EoC from March 2012 to March 2017, based on the Systematized Nomenclature of Medicine Clinical Terms. We calculated the overall prevalence of EoGE and EoC among different patient groups, and performed age- and gender-adjusted analyses to assess for differences in the prevalence of associated medical conditions in patients with EoGE and EoC and control patients (patients in the database between March 2012 and March 2017 without EGID-associated diagnoses). RESULTS Of the 35,826,830 individuals in the database, we identified 1820 patients with EoGE and 770 with EoC. The overall prevalence rate of EoGE was 5.1/100,000 persons; the overall prevalence rate of EoC was 2.1/100,000 persons. Each of the non-EoE EGIDs was more prevalent in Caucasians than in African-Americans and Asians, and in female patients than male patients. Although EoGE was more prevalent in children (under 18 years of age) than in adults, EoC was more prevalent in adults (older than 18 years of age). Compared with control patients, individuals with non-EoE EGIDs were more likely to have been diagnosed with other gastrointestinal or allergic disorders. CONCLUSIONS In a population-based study in the United States, using the Explorys database, we found the overall prevalence rate of EoGE to be 5.1/100,000 persons and the prevalence rate of EoC to be 2.1/100,000; these values are at the lower end of prevalence rates previously reported in the United States.
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12
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Specific MicroRNA Pattern in Colon Tissue of Young Children with Eosinophilic Colitis. Int J Mol Sci 2017; 18:ijms18051050. [PMID: 28498330 PMCID: PMC5454962 DOI: 10.3390/ijms18051050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/15/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Eosinophilic colitis (EC) is a common cause of haematochezia in infants and young children. The exact pathomechanism is not understood, and the diagnosis is challenging. The role of microRNAs as key class of regulators of mRNA expression and translation in patients with EC has not been explored. Therefore, the aim of the present study was to explore the miRNA profile in EC with respect to eosinophilic inflammation. Patients enrolled in the study (n = 10) had persistent rectal bleeding, and did not respond to elimination dietary treatment. High-throughput microRNA sequencing was carried out on colonic biopsy specimens of children with EC (EC: n = 4) and controls (C: n = 4) as a preliminary screening of the miRNA profile. Based on the next-generation sequencing (NGS) results and literature data, a potentially relevant panel of miRNAs were selected for further measurements by real-time reverse transcription (RT)-PCR (EC: n = 14, C: n = 10). Validation by RT-PCR resulted in significantly altered expression of miR-21, -31, -99b, -125a, -146a, -184, -221, -223, and -559 compared to controls (p ≤ 0.05). Elevation in miR-21, -99b, -146a, -221, and -223 showed statistically significant correlation to the extent of tissue eosinophilia. Based on our results, we conclude that the dysregulated miRNAs have a potential role in the regulation of apoptosis by targeting Protein kinase B/Mechanistic target of rapamycin (AKT/mTOR)-related pathways in inflammation by modulating Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)-related signalling and eosinophil cell recruitment and activation, mainly by regulating the expression of the chemoattractant eotaxin and the adhesion molecule CD44. Our results could serve as a basis for further extended research exploring the pathomechanism of EC.
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Browning KN, Verheijden S, Boeckxstaens GE. The Vagus Nerve in Appetite Regulation, Mood, and Intestinal Inflammation. Gastroenterology 2017; 152:730-744. [PMID: 27988382 PMCID: PMC5337130 DOI: 10.1053/j.gastro.2016.10.046] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/27/2016] [Accepted: 10/27/2016] [Indexed: 02/07/2023]
Abstract
Although the gastrointestinal tract contains intrinsic neural plexuses that allow a significant degree of independent control over gastrointestinal functions, the central nervous system provides extrinsic neural inputs that modulate, regulate, and integrate these functions. In particular, the vagus nerve provides the parasympathetic innervation to the gastrointestinal tract, coordinating the complex interactions between central and peripheral neural control mechanisms. This review discusses the physiological roles of the afferent (sensory) and motor (efferent) vagus in regulation of appetite, mood, and the immune system, as well as the pathophysiological outcomes of vagus nerve dysfunction resulting in obesity, mood disorders, and inflammation. The therapeutic potential of vagus nerve modulation to attenuate or reverse these pathophysiological outcomes and restore autonomic homeostasis is also discussed.
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Affiliation(s)
- Kirsteen N. Browning
- Department of Neural and Behavioral Science Penn State College of Medicine 500 University Drive MC H109 Hershey, PA 17033
| | - Simon Verheijden
- Translational Research Center of Gastrointestinal Disorders (TARGID) KU Leuven Herestraat 49 3000 Leuven, Belgium
| | - Guy E. Boeckxstaens
- Translational Research Center of Gastrointestinal Disorders (TARGID) KU Leuven Herestraat 49 3000 Leuven, Belgium,Division of Gastroenterology & Hepatology University Hospital Leuven Herestraat 49 3000 Leuven, Belgium,Address of correspondence: Prof. dr. Guy Boeckxstaens,
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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.
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Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database. J Pediatr Gastroenterol Nutr 2016; 62:36-42. [PMID: 25988554 PMCID: PMC4654708 DOI: 10.1097/mpg.0000000000000865] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the United States. METHODS We used the IMS Health LifeLink PharMetrics Plus Claims Database, data representative of a US national commercially insured population containing medical and pharmaceutical claims for > 75 million individuals. We restricted our sample to patients ages 0 to 64 with continuous enrollment between July 1, 2009, and June 30, 2011. We identified patients with eosinophilic gastritis, gastroenteritis, and colitis as defined by ≥ 1 instance of the International Classification of Diseases, Ninth Revision codes 535.70, 558.41, and 558.42, respectively. We calculated the prevalence of the codes in the database and then standardized the estimates to the US population by age and sex. RESULTS The standardized estimated prevalences of eosinophilic gastritis, gastroenteritis, and colitis were 6.3/100,000, 8.4/100,000, and 3.3/100,000, respectively. The prevalence of eosinophilic gastroenteritis was the highest among children age < 5 years, whereas eosinophilic gastritis was more prevalent among older age groups. We observed no age differences for eosinophilic colitis. Among affected patients, there was a high proportion of coexisting allergic conditions, 38.5% for eosinophilic gastritis, 45.6% for gastroenteritis, and 41.8% for colitis. Concomitant allergic disease was most commonly identified in pediatric patients. CONCLUSIONS The prevalence of non-EoE EGIDs remains rare in the United States, with < 50,000 total patients affected. There appears to be a female predominance and a high co-occurrence of atopic comorbidities.
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Choi BS, Hong SJ, Park SH, Kim HM, Choe BH. Differences in Features and Course of Mucosal Type Eosinophilic Gastroenteritis between Korean Infants and Children. J Korean Med Sci 2015; 30:1129-35. [PMID: 26240491 PMCID: PMC4520944 DOI: 10.3346/jkms.2015.30.8.1129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/09/2015] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic gastroenteritis (EGE) is a disorder characterized by eosinophilic infiltration of the bowel wall and various gastrointestinal (GI) manifestations. This study aimed to evaluate the characteristics of EGE in infants and children. A total of 22 patients were diagnosed with histologic EGE (hEGE) or possible EGE (pEGE). Serum specific IgE levels, peripheral eosinophil counts, and endoscopic biopsies were carried out. In the hEGE group (n = 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group. All patients in the infant group showed clinical improvement after switching from cow's milk feeding to special formula or breast feeding. The infant group showed a higher eosinophil count in the gastric mucosal biopsy than the child group. In the pEGE group (n = 9) initial symptoms included hematemesis, abdominal pain, and vomiting. Seven patients in this group showed a good response to treatment with restriction of the suspected foods and/or the administration of ketotifen. Both hEGE and pEGE groups showed clinical improvement after restriction of suspected foods in the majority of cases and also showed a similar clinical course. EGE should be considered in the differential diagnosis of patients with chronic abdominal pain, vomiting, and hematemesis of unknown cause. The infant group may have a better prognosis than the child group if treated properly.
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Affiliation(s)
- Bong Seok Choi
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Suk Jin Hong
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Suk Hyun Park
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Heng Mi Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Byung-Ho Choe
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Ishii H, Konuma T, Kato S, Ota Y, Tojo A, Takahashi S. Eosinophilic gastroenteritis after allogeneic bone marrow transplantation. Ann Hematol 2015; 94:1435-6. [DOI: 10.1007/s00277-015-2388-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/19/2015] [Indexed: 11/25/2022]
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18
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Yang M, Geng L, Chen P, Wang F, Xu Z, Liang C, Li H, Fang T, Friesen CA, Gong S, Li D. Effectiveness of dietary allergen exclusion therapy on eosinophilic colitis in Chinese infants and young children ≤ 3 years of age. Nutrients 2015; 7:1817-27. [PMID: 25768952 PMCID: PMC4377883 DOI: 10.3390/nu7031817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic colitis is a well recognized clinical entity mainly associated with food allergies. Empiric treatment options include dietary allergen exclusion (extensively hydrolyzed protein formula and elimination diet), anti-allergy medications (antihistamines and leukotriene receptor antagonists) and corticosteroids. We evaluated the effectiveness of dietary antigen exclusion on clinical remission of eosinophilic colitis in infants and young children. We retrospectively reviewed charts of all infants and children ≤3 years of age who were diagnosed with eosinophilic colitis (defined as mucosal eosinophilia ≥20 hpf−1) from 1 January 2011 to 31 December 2013 at a tertiary children’s hospital in China. Forty-nine children were identified with eosinophilic colitis. Elemental formula, simple elimination diet or combination therapy resulted in clinical improvement in 75%, 88.2% and 80% of patients, respectively. In conclusion, eosinophilic colitis in infants and children ≤3 years of age responded well to dietary allergen exclusion.
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Affiliation(s)
- Min Yang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Lanlan Geng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Peiyu Chen
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Fenghua Wang
- Department of Pathology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Zhaohui Xu
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Cuiping Liang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Huiwen Li
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Tiefu Fang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Craig A Friesen
- Division of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City 64108, MO, USA.
| | - Sitang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Dingyou Li
- Division of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City 64108, MO, USA.
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Caglar E, Sezgin Caglar A, Gokturk S, Dobrucali A. A Case of Eosinophilic Gastroenteritis with Ascites. Case Rep Med 2015; 2015:971607. [PMID: 26819619 PMCID: PMC4706876 DOI: 10.1155/2015/971607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/10/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023] Open
Abstract
Eosinophilic gastroenteritis is a rare disorder of unknown cause characterized by focal or diffuse eosinophilic infiltration of gastrointestinal tract, especially the stomach and duodenum. Its clinical presentation depends on which segment of gastrointestinal tract is affected and on the depth of eosinophilic infiltration in the affected segment. We present a case of a 35-year-old male with abdominal distention for six months. Laboratory testing revealed elevated eosinophil count and serum immunoglobulin E (IgE) levels. In abdominal tomography, ascites was observed, and eosinophilic infiltration was detected in duodenum biopsy samples, collected during endoscopic examination of upper gastrointestinal system. Clinical and pathologic findings of the patient responded to steroid dramatically. Even though their comorbidity is rare, eosinophilic gastroenteritis should be considered in differential diagnosis of patients with unspecified ascites.
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Affiliation(s)
- Erkan Caglar
- 1Cerrahpasa Medical Faculty, Gastroenterology Department, Istanbul University, 34098 Istanbul, Turkey
- *Erkan Caglar:
| | | | - Suut Gokturk
- 3Bakirkoy Training and Education Hospital, Clinic of Gastroenterology, 34147 Istanbul, Turkey
| | - Ahmet Dobrucali
- 1Cerrahpasa Medical Faculty, Gastroenterology Department, Istanbul University, 34098 Istanbul, Turkey
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Intestinal permeability--a new target for disease prevention and therapy. BMC Gastroenterol 2014; 14:189. [PMID: 25407511 PMCID: PMC4253991 DOI: 10.1186/s12876-014-0189-7] [Citation(s) in RCA: 1055] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 10/17/2014] [Indexed: 02/06/2023] Open
Abstract
Data are accumulating that emphasize the important role of the intestinal barrier and intestinal permeability for health and disease. However, these terms are poorly defined, their assessment is a matter of debate, and their clinical significance is not clearly established. In the present review, current knowledge on mucosal barrier and its role in disease prevention and therapy is summarized. First, the relevant terms 'intestinal barrier' and 'intestinal permeability' are defined. Secondly, the key element of the intestinal barrier affecting permeability are described. This barrier represents a huge mucosal surface, where billions of bacteria face the largest immune system of our body. On the one hand, an intact intestinal barrier protects the human organism against invasion of microorganisms and toxins, on the other hand, this barrier must be open to absorb essential fluids and nutrients. Such opposing goals are achieved by a complex anatomical and functional structure the intestinal barrier consists of, the functional status of which is described by 'intestinal permeability'. Third, the regulation of intestinal permeability by diet and bacteria is depicted. In particular, potential barrier disruptors such as hypoperfusion of the gut, infections and toxins, but also selected over-dosed nutrients, drugs, and other lifestyle factors have to be considered. In the fourth part, the means to assess intestinal permeability are presented and critically discussed. The means vary enormously and probably assess different functional components of the barrier. The barrier assessments are further hindered by the natural variability of this functional entity depending on species and genes as well as on diet and other environmental factors. In the final part, we discuss selected diseases associated with increased intestinal permeability such as critically illness, inflammatory bowel diseases, celiac disease, food allergy, irritable bowel syndrome, and--more recently recognized--obesity and metabolic diseases. All these diseases are characterized by inflammation that might be triggered by the translocation of luminal components into the host. In summary, intestinal permeability, which is a feature of intestinal barrier function, is increasingly recognized as being of relevance for health and disease, and therefore, this topic warrants more attention.
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21
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Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Raithel M, Hahn M, Donhuijsen K, Hagel AF, Nägel A, Rieker RJ, Neurath MF, Reinshagen M. Eosinophilic gastroenteritis with refractory ulcer disease and gastrointestinal bleeding as a rare manifestation of seronegative gastrointestinal food allergy. Nutr J 2014; 13:93. [PMID: 25228412 PMCID: PMC4175623 DOI: 10.1186/1475-2891-13-93] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/12/2014] [Indexed: 12/22/2022] Open
Abstract
Gastrointestinal bleeding and iron deficiency anaemia may cause severe symptoms and may require extensive diagnostics and substantial amounts of health resources.This case report focuses on the clinical presentation of a 22 year old patient with recurrent gastrointestinal bleeding from multilocular non-healing ulcers of the stomach, duodenum and jejunum over a period of four years. Extensive gastroenterological and allergological standard diagnostic procedures showed benign ulcerative lesions with tissue eosinophilia, but no conclusive diagnosis. Multiple diagnostic procedures were performed, until finally, endoscopically guided segmental gut lavage identified locally produced, intestinal IgE antibodies by fluoro-enzyme-immunoassay.IgE antibody concentrations at the intestinal level were found to be more-fold increased for total IgE and food-specific IgE against nuts, rye flour, wheat flour, pork, beef and egg yolk compared with healthy controls.Thus, a diet eliminating these allergens was introduced along with antihistamines and administration of a hypoallergenic formula, which resulted in complete healing of the multilocular ulcers with resolution of gastrointestinal bleeding. All gastrointestinal lesions disappeared and total serum IgE levels dropped to normal within 9 months. The patient has been in remission now for more than two years.Eosinophilic gastroenteritis (EG) is well known to induce refractory ulcer disease. In this case, the mechanisms for intestinal damage and gastrointestinal bleeding were identified as local gastrointestinal type I allergy. Therefore, future diagnostics in EG should also be focused on the intestinal level as identification of causative food-specific IgE antibodies proved to be effective to induce remission in this patient.
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Affiliation(s)
- Martin Raithel
- Department of Medicine I, University Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
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Kotlyar DS, Shum M, Hsieh J, Blonski W, Greenwald DA. Non-pulmonary allergic diseases and inflammatory bowel disease: A qualitative review. World J Gastroenterol 2014; 20:11023-11032. [PMID: 25170192 PMCID: PMC4145746 DOI: 10.3748/wjg.v20.i32.11023] [Citation(s) in RCA: 18] [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: 09/17/2013] [Revised: 01/06/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
While the etiological underpinnings of inflammatory bowel disease (IBD) are highly complex, it has been noted that both clinical and pathophysiological similarities exist between IBD and both asthma and non-pulmonary allergic phenomena. In this review, several key points on common biomarkers, pathophysiology, clinical manifestations and nutritional and probiotic interventions for both IBD and non-pulmonary allergic diseases are discussed. Histamine and mast cell activity show common behaviors in both IBD and in certain allergic disorders. IgE also represents a key immunoglobulin involved in both IBD and in certain allergic pathologies, though these links require further study. Probiotics remain a critically important intervention for both IBD subtypes as well as multiple allergic phenomena. Linked clinical phenomena, especially sinonasal disease and IBD, are discussed. In addition, nutritional interventions remain an underutilized and promising therapy for modification of both allergic disorders and IBD. Recommending new mothers breastfeed their infants, and increasing the duration of breastfeeding may also help prevent both IBD and allergic diseases, but requires more investigation. While much remains to be discovered, it is clear that non-pulmonary allergic phenomena are connected to IBD in a myriad number of ways and that the discovery of common immunological pathways may usher in an era of vastly improved treatments for patients.
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Wang NN, Li YL, Sun MJ. Eosinophilic gastroenteritis manifesting as pyloric obstruction, intestinal obstruction and ascites: A case report. Shijie Huaren Xiaohua Zazhi 2013; 21:1785-1788. [DOI: 10.11569/wcjd.v21.i18.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic gastroenteritis (EG) is a rare disease of unknown cause, characterized by peripheral eosinophilia, eosinophilic infiltration and edema of the gastrointestinal tract. Here we report a case of eosinophilic gastroenteritis manifesting as pyloric obstruction, intestinal obstruction and ascites. A 33-year-old male patient presented with a chief complaint of heartburn and eructation for 3 years, abdominal pain and diarrhea for 2 years, and abdominal distension for 1.5 years. He underwent subtotal gastrectomy because of pyloric obstruction 2 years ago and was pathologically diagnosed with eosinophilic gastritis involving the duodenum. Subsequently, he developed ascites and intestinal obstruction, and his WBC count was 21.07 × 109/L and his eosinophil percentage was 70.4% at that time. After taking some traditional Chinese medicine whose ingredient is not clear for 1 mo, his symptoms were relieved. One month ago he developed ascites again. His eosinophil percentage was 90% in ascites, and his WBC count was 34.50 × 109/L and his eosinophil percentage was 82.1% in blood. Microscopic examination of biopsied specimens showed eosinophilic infiltration. After treatment with methylprednisolone, his symptoms regressed.
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Molnár K, Pintér P, Győrffy H, Cseh &A, Müller KE, Arató A, Veres G. Characteristics of allergic colitis in breast-fed infants in the absence of cow’s milk allergy. World J Gastroenterol 2013; 19:3824-3830. [PMID: 23840121 PMCID: PMC3699042 DOI: 10.3748/wjg.v19.i24.3824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/23/2012] [Accepted: 03/27/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the characteristics of mucosal lesions and their relation to laboratory data and long-term follow up in breast-fed infants with allergic colitis.
METHODS: In this study 31 breast-fed infants were prospectively evaluated (mean age, 17.4 wk) whose rectal bleeding had not ceased after a maternal elimination diet for cow’s milk. Thirty-four age-matched and breast-fed infants (mean age, 16.9 wk) with no rectal bleeding were enrolled for laboratory testing as controls. Laboratory findings, colonoscopic and histological characteristics were prospectively evaluated in infants with rectal bleeding. Long-term follow-up with different nutritional regimes (L-amino-acid based formula or breastfeeding) was also included.
RESULTS: Iron deficiency, peripheral eosinophilia and thrombocytosis were significantly higher in patients with allergic colitis in comparison to controls (8.4 ± 3.2 μmol/L vs 13.7 ± 4.7 μmol/L, P < 0.001; 0.67 ± 0.49 G/L vs 0.33 ± 0.17 G/L, P < 0.001; 474 ± 123 G/L vs 376 ± 89 G/L, P < 0.001, respectively). At colonoscopy, lymphonodular hyperplasia or aphthous ulceration were present in 83% of patients. Twenty-two patients were given L-amino acid-based formula and 8 continued the previous feeding. Time to cessation of rectal bleeding was shorter in the special formula feeding group (mean, 1.4 wk; range, 0.5-3 wk) when compared with the breast-feeding group (mean, 5.3 wk; range, 2-9 wk). Nevertheless, none of the patients exhibited rectal bleeding at the 3-mo visit irrespective of the type of feeding. Peripheral eosinophilia and cessation of rectal bleeding after administration of elemental formula correlated with a higher density of mucosal eosinophils.
CONCLUSION: Infant hematochezia, after cow’s milk allergy exclusion, is generally a benign and probably self-limiting disorder despite marked mucosal abnormality. Formula feeding results in shorter time to cessation of rectal bleeding; however, breast-feeding should not be discouraged in long-lasting hematochezia.
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Boeckxstaens G. The clinical importance of the anti-inflammatory vagovagal reflex. HANDBOOK OF CLINICAL NEUROLOGY 2013; 117:119-34. [PMID: 24095121 DOI: 10.1016/b978-0-444-53491-0.00011-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Excessive activation of the immune system is prevented by anti-inflammatory mediators such as corticosteroids and anti-inflammatory cytokines. Recently, it became clear that the brain not only senses peripheral inflammation through vagal afferent nerve fibers, but also provides an integrated response dampening the immune system through vagal efferents. This so-called anti-inflammatory pathway has been introduced as a third system by which the immune system is modulated. In sepsis, the anti-inflammatory effect is mediated by modulation of splenic macrophages, whereas in the gut, vagal nerve fibers synapse with enteric cholinergic neurons interacting with resident intestinal macrophages. In this chapter, the preclinical data underscoring the importance of this pathway are summarized, and its clinical significance is reviewed. Finally, the current data supporting its relevance to human disease and its therapeutic potential will be discussed. Insight in the mechanisms underlying these crucial properties will lead to better understanding of immune-mediated diseases and ultimately to improved anti-inflammatory therapies.
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Affiliation(s)
- G Boeckxstaens
- Department of Gastroenterology, University Hospital Leuven, University of Leuven, Leuven, Belgium.
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27
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Pickert CN, Lorentz A, Manns MP, Bischoff SC. Colonoscopic allergen provocation test with rBet v 1 in patients with pollen-associated food allergy. Allergy 2012; 67:1308-15. [PMID: 22913618 DOI: 10.1111/all.12006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND After consumption of fruits, nuts, and vegetables, several patients with pollen allergy experience gastrointestinal (GI) tract symptoms that are possibly caused by pollen-associated food allergy. The aim of this study was to evaluate the colonoscopic allergen provocation (COLAP) test using the recombinant birch pollen allergen Bet v 1 (rBet v 1) for in vivo diagnosis of pollen-associated food allergy manifesting in the GI tract. METHODS Thirty-four patients with a history of adverse reactions to food, GI tract symptoms, and birch pollen pollinosis and five healthy controls underwent COLAP test. Twenty minutes after endoscopic challenge of the cecal mucosa with rBet v 1, the mucosal wheal and flare reaction was registered semiquantitatively, and tissue biopsy specimens were examined for eosinophil mucosal activation. RESULTS The mucosal reaction to rBet v 1 was correlated with the presence of pollinosis (P = 0.004), history of adverse reaction to Bet v 1-associated food allergens (P = 0.001), and tissue eosinophils' activation (P < 0.001). A wheal and flare reaction in the COLAP test was observed in 13 of 16 patients (81%) with a history of GI tract symptoms associated with the ingestion of Bet v 1-related foods and in four of 18 (22%) patients with a negative history (P < 0.001). The control group did not develop visible mucosal reactions to rBet v 1. Systemic anaphylactic reactions did not occur. CONCLUSIONS The mucosal administration of rBet v 1 by COLAP test provides a new diagnostic tool that might support the diagnosis of Bet v 1-associated food allergy manifesting in the GI tract.
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Affiliation(s)
- C. N. Pickert
- Department of Gastroenterology, Hepatology and Endocrinology; Medical School of Hannover; Hannover; Germany
| | - A. Lorentz
- Department of Nutritional Medicine; University of Hohenheim; Stuttgart; Germany
| | - M. P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology; Medical School of Hannover; Hannover; Germany
| | - S. C. Bischoff
- Department of Nutritional Medicine; University of Hohenheim; Stuttgart; Germany
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Lee DR. A case of eosinophilic gastrointestinal disorders presenting with chronic diarrhea and abdominal pain. Korean J Fam Med 2012; 32:257-62. [PMID: 22745862 PMCID: PMC3383135 DOI: 10.4082/kjfm.2011.32.4.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/19/2011] [Indexed: 11/18/2022] Open
Abstract
Eosinophilic gastrointestinal disorders (EGID) are rare conditions characterized by eosinophilic infiltration of the bowel wall and gastrointestinal symptoms. These disorders can present with various manifestations, depending on the specific site of the affected gastrointestinal tract and specific layer of the affected gastrointestinal wall. The pathogenesis and etiology of EGID remain unclear. The present case report describes a 76-year-old woman who presented with chronic diarrhea and lower abdominal pain. The patient was successfully treated with corticosteroid and restriction of some food allergens. One needs to consider these rare disorders during the differential diagnosis of unexplained gastrointestinal symptoms, especially when they are associated with peripheral eosinophilia.
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Affiliation(s)
- Dong-Ryul Lee
- Department of Family Medicine, Sanbon Medical Center, Wonkwang University College of Medicine, Gunpo, Korea
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Huang YQ, Han CL, Liu XY. Eosinophilic gastroenteritis with bloody ascites: a case report. Shijie Huaren Xiaohua Zazhi 2012; 20:980-983. [DOI: 10.11569/wcjd.v20.i11.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic gastroentertis (EG) is a very rare disease of unknown cause, characterized by peripheral eosinophilia and focal or difuse eosinophilic infiltration of the gastrointestinal tract. Here we report a case of eosinophilic gastroenteritis with bloody ascites in a 15-year-old male patient who presented to our hospital with nausea, vomiting, debilitation, and intermittent diarrhea for 10 d. Laboratory data showed that his WBC count was 18.28×109/L and his eosinophil percentage was 57.61%. He developed bloody ascitic fluid, in which the protein level was 46 g/L, WBC count was 7040×106/L, and eosinophil percentage was 68%. The Rivalta test was positive. Ultrasound and CT demonstrated bowel wall thickness in the right colon and ascites. Gastroendoscopy showed severe multifocal erythematous esophagitis, gastritis and duodenitis, and a ring-like discoloration with mucosal particle hyperplasia in the lower esophagus. Colonoscopy revealed severe inflammation in the lower ileum, the opening of vermiform appendix, and right colon, with erosions, thickening, exudates, mucosal particle hyperplasia, and stricture formation. Microscopic examination of the biopsied specimens showed eosinophilic infiltration. After treatment with prednisone, his clinical manifestations regressed.
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Factors contributing to adherence to dietary treatment of eosinophilic gastrointestinal diseases. J Pediatr Gastroenterol Nutr 2012; 54:430-2. [PMID: 22094899 DOI: 10.1097/mpg.0b013e3182407aee] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The purpose of the present study was to identify barriers to dietary adherence found in the treatment of children with eosinophilic gastrointestinal diseases (EGIDs) and food allergy. A prospective study using a self-administered survey to parents of children with EGIDs at a national advocacy meeting was completed. Responses from 45 participants describing children ages 1 to 18 years (69% boys) identified that 63% were adherent to food restrictions. Physicians provided dietary instructions more often than dietitians. Nonadherence was associated with lack of school support (P < 0.027). Access to a dietitian may improve the care of children with EGIDs.
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Hurrell JM, Genta RM, Melton SD. Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract. Adv Anat Pathol 2011; 18:335-48. [PMID: 21841404 DOI: 10.1097/pap.0b013e318229bfe2] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eosinophils, a constitutive component of the columnar-lined gastrointestinal tract, play an essential role in allergic responses and parasitic infections. The tissue density of these cells also increases in a variety of conditions of uncertain etiology. With the exception of the esophageal squamous epithelium, in which no eosinophils are normally present, the population of normal eosinophils in the remainder of the luminal gut is poorly defined. Therefore, histopathologists must rely on their subjective judgment to determine when a diagnosis of eosinophilic gastritis, enteritis, or colitis should be rendered. Eosinophilic esophagitis is currently the best defined and most studied eosinophilic condition of the digestive tract; therefore, the confidence in accurate diagnosis is increasing. In contrast, the characteristic clinicopathologic features of eosinophilic conditions affecting other parts of the digestive tract remain somewhat elusive. This review was designed to present pathologists with simple and practical information for the biopsy-based histopathologic diagnosis of eosinophilic esophagitis, gastritis, enteritis, and colitis. It was prepared by critically reviewing more than 200 articles on the topic, along with incorporating evidence accumulated through our own collective experience. We anticipate that by increasing pathologists' confidence in reporting these abnormal but often nameless eosinophilic infiltrates, we can help better define and characterize their significance.
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Affiliation(s)
- Jennifer M Hurrell
- Department of Pathology, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, USA
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Successful treatment of eosinophilic colitis by montelukast sodium plus budesonide in a patient with Waldenstrom macroglobulinemia. J Crohns Colitis 2011; 5:277-8. [PMID: 21575902 DOI: 10.1016/j.crohns.2011.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 02/08/2023]
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