Dietary guidance normalizes large intestinal endocrine cell densities in patients with irritable bowel syndrome.

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/mm(2) 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/mm(2), 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/mm(2) 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.

Effect of dietary management on the gastric endocrine cells in patients with irritable bowel syndrome.

BACKGROUND/OBJECTIVES: The gastric endocrine cells in patients with irritable bowel syndrome (IBS) tend to normalize following dietary guidance. The aim of the present study was to identify the gastric endocrine cell types that are changed following such dietary guidance. SUBJECTS/METHODS: Fourteen IBS patients and 14 healthy subjects were included in the study. Patients received three sessions of individual dietary management guidance. Gastroscopy was performed on both the controls and the patients at baseline and then again for the patients at 3-9 months after dietary guidance. Biopsy samples from the corpus and antrum were immunostained for all gastric endocrine cell types. Endocrine cells were quantified by computerized image analysis. RESULTS: The densities of the ghrelin cells for the controls and IBS patients before and after dietary guidance were 149.6 ± 36.2 (mean ± s.e.m.; 95% confidence interval (CI) 71.3-227.8), 114.5 ± 32.7 and 161.8 ± 37.8 cells/mm(2), respectively. The densities of the gastrin cells in these groups were 155.8 ± 21.0 (95% CI 110.3-201.2), 159.4 ± 24.3 and 211.6 ± 28.0 cells/mm(2), respectively; the corresponding densities of serotonin cells in the corpus were 18.2 ± 3.9 (95% CI 9.8-26.6), 10.6 ± 3.4 and 14 ± 2.0 cells/mm(2) and in the antrum were 44.6 ± 12.2 (95% CI 18.1-71.1), 1.7 ± 0.5 and 14.7 ± 6.3 cells/mm(2). The densities of the somatostatin cells in the corpus were 40.0 ± 7.7 (95% CI 23.5-56.5), 23.0 ± 3.0 and 37.3 ± 4.2 cells/mm(2), respectively, and in the antrum were 138.9 ± 22.0 (95% CI 91.4-186.3), 95.6 ± 15.9 and 86.0 ± 16.9 cells/mm(2), respectively. CONCLUSIONS: The densities of all of the gastric endocrine cell types changed towards the healthy control values in the IBS patients following a change in food intake.

Chromogranin A cell density in the rectum of patients with irritable bowel syndrome.

In a previous study, chromogranin A (CgA) cell density in the colon of patients with irritable bowel syndrome (IBS) was found to be reduced. It has been suggested that intestinal CgA cell density may be used as a marker for the diagnosis of IBS. The rectum harbours a larger number of large intestinal endocrine cells and is more accessible for biopsies than the colon. The present study aimed at determining the CgA cell density in the rectum of IBS patients. A total of 47 patients with IBS that fulfilled the Rome Criteria III (39 females and 8 males; average age, 38 years) were included. A total of 28 patients had diarrhea (IBS-D) and 19 had constipation (IBS-C) as the predominant symptom. A total of 27 subjects that underwent colonoscopy with rectal biopsies were used as the controls. These subjects underwent colonoscopy due to gastrointestinal bleeding (the source of which was identified as haemorrhoids or angiodysplasia; 19 females and 8 males; average age, 49 years), or health worries. The rectal biopsies were immunostained for CgA and quantified by computer image analysis. The CgA density in the controls was 206.3±22.2 (mean ± SEM), in all IBS patients 190.2±14.3, in IBS-D patients 188.8±14.7 and in IBS-C patients 195.3±34.1. There was no statistically significant difference between the controls, IBS, IBS-D or IBS-C patients (P=0.5, 0.5 and 0.7, respectively). The present study showed that although the rectum comprises the same endocrine cell types as the colon, attention must be paid when drawing conclusions regarding the whole large intestine from studies carried out on the rectum. This particularly applies when endocrine cells are investigated. As CgA cell density represents the total endocrine cell content of the rectum, changes in specific endocrine cells in IBS patients cannot be excluded.