Mo2012 Confocal Laser Endomicroscopy in Patients With Irritable Bowel Syndrome (IBS)

Abstract

Introduction: IBS is a symptom-based diagnosis characterized by chronic abdominal pain, bloating, and alterations of the bowel habits without any organic cause. CLE allows in vivo visualization of microscopic features of the intestinal epithelium in real time during endoscopy. Aims: Primary study objective was to assess the potential of CLE to demask subtle mucosal changes of the small and large bowel mucosa in patients with established diagnosis of IBS. Material & Methods: Patients with established diagnosis of IBS according to RomeIII criteria and control patients underwent ileocolonoscopy. Fluoresceine guided CLE was performed in the terminal ileum and random optical biopsies were additionally performed in the colon and rectum. Attention was paid to presence or absence of epithelial gaps, intramucosal bacteria, crypt and vessel morphology, goblet cells and cellular infiltrate within the lamina propria. Physical biopsies were additionally taken for histopathological analysis. Results: In a subgroup (44%) of patients with IBS according to Rome-III epithelial gap density and the microvascular pattern were increased compared to control patients suggesting an altered intestinal permeability. No differences were observed regarding the presence of intramucosal bacteria, colonic crypt morphology, presence of goblet cells or the cellular infiltrate within the lamina propria (P >0.05). Conclusion: Confocal laser endomicroscopy revealed subtle mucosal changes in patients with IBS. These findings were not visible in all IBS patients suggesting that only a subgroup of IBS patients may have an organic cause of the disease.