Abstract
Background/Objectives:To determine the large intestinal endocrine cell types affected following dietary guidance in patients with irritable bowel syndrome (IBS).Subjects/Methods:The study included 13 IBS patients and 13 control subjects. The patients received three sessions of individualized dietary guidance. Both the control subjects and the patients were scheduled for colonoscopies at baseline and again for the patients at 3–9 months after dietary guidance. Biopsy samples were taken from the colon and rectum and were immunostained for all types of large intestinal endocrine cells. The endocrine cells were quantified using computerized image analysis.Results:The daily total consumption (mean±s.e.m. values) of fruits and vegetables rich in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) decreased significantly from 16.2±5.3 g before receiving dietary guidance to 9.2±3.2 g after receiving dietary guidance (P=0.02). In the total colon, the densities of serotonin cells were 46.8±8.9, 10.5±2.1 and 22.6±3.2 cells/mm2 in control subjects and in IBS patients before and after receiving dietary guidance, respectively (P=0.007); the corresponding densities of peptide YY cells were 11.6±1.8, 10.8±1.7 and 16.8±2.1 cells/mm2, respectively (P=0.06). The cell densities for both serotonin and peptide YY did not change significantly in the rectum. The densities of somatostatin cells in the rectum were 13.5±3.0, 13.2±3.0, and 22.3±3.2 cells/mm2 for control subjects and for IBS patients before and after receiving dietary guidance, respectively (P=0.01).Conclusions:The densities of the large intestinal endocrine cells tend to normalize following dietary guidance that may have contributed to the improvement of the patients with IBS symptoms.
Highlights
Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal (GI) disorder.[1]
After the first session and colonoscopy, four patients were excluded after being diagnosed with celiac disease (n = 2) and lupus (n = 1) and because of 178 dietary guidance and/or because they were unwilling for a second colonoscopy to be performed
The dropout rate in the present study was 52%, somewhat higher than previously reported rates (33–48%).[35,39,40,41,42]. This higher dropout rate could be explained by the demanding design of the study, involving two colonoscopies and requiring the patients to follow a strict diet for at least 3 months
Summary
Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal (GI) disorder.[1] Besides its associated morbidity, IBS patients exhibit a high consumption of health-care resources that represents an economic burden to society as a whole.[1,2,3,4]. There is increasing evidence that IBS can result from dysfunction of the GI neuroendocrine system and GI endocrine cells in particular.[5,6,7,8,9,10,11,12,13,14,15,16]. The GI endocrine cells are scattered among the epithelial cells lining the GI lumen.[17,18,19] These endocrine cells interact with the GI luminal contents (especially nutrients) and respond by releasing specific hormones that affect different functions of the GI tract.[5,20,21,22,23,24,25,26,27,28,29,30,31]
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