2906 Significantly Increased Mucosal Eosinophils in Patients With Post-IBD IBS-D May Have a New Avenue

Abstract

INTRODUCTION: Inflammatory bowel disease (IBD) patients in remission who present with irritable bowel syndrome with diarrhea (IBS-D) like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD-IBS-D. This syndrome was first reported by Isgar et al. who documented IBS-type symptoms in 33% of their patients with chronic ulcerative colitis (CUC) in remission in 1983. In their meta-analysis of 13 studies incorporating 1703 patients, Halpin and Ford in 2012 calculated a pooled prevalence for IBS symptoms among IBD subjects in remission of 35%. The post-IBD IBS-D represents a source of considerable stress, incurs morbidity and impairs quality of life of these patients. The etiology of this syndrome is unknown and may be multifactorial such as environmental, psychological and genetic components and possibly by gut microbiome. METHODS: We conducted a retrospective, single-center electronic medical record review of patients with history of IBD and IBS-D like symptoms. The demographic characteristics, type of IBD, colonoscopy and biopsy findings with GI-hypoallergenic diet and budesonide treatment were analyzed. RESULTS: We have found significantly increased mucosal eosinophils (>30-50 HPF in both side of the colon examined) in our patients with post- IBD IBS-D syndrome. In this study, 15 patients with CUC and 20 Crohn's disease (CD) patients with this syndrome were investigated and showed no clinical, serological, mucosal or microscopic IBD activity. These patients had non-bloody diarrhea (3-20x daily), lower abdominal cramps (90%), mild weight loss (4-6 lbs), and fecal incontinence (25%) who were placed on the GI-hypoallergenic diet and budesonide therapy. Sixty-seven percent of these 35 patients with post- IBD IBS-D responded well clinically to this management. Increased mucosal eosinophils in these patients may have eosinophilic colopathy that may be related to intestinal permeability disarray. The epithelium in these IBD patients who are in remission may have the production of pro-inflammatory cytokines by the eosinophils, especially IL-23 and IL-33. CONCLUSION: In summary, this is an exciting new findings that significantly increased mucosal eosinophils in our patients with post-IBD IBS-D may have a new avenue, eosinophilic colopathy. Interestingly, these patients have responded to the GI-hypoallergenic diet and budesonide therapy. Obviously, we need more patients in the near future with a longer follow-up and we hope that the other investigators may confirm our findings.