Mast cell and cellularity of the colonic mucosa correlated with fatigue and depression in the irritable bowel syndrome

Thierry Piche ^1*, Marie Christine Saint Paul ², Raffaella Dainese ³, Eugenia Marine-Barjoan ³, Antonio Iannelli ³, Marie Lyse Montoya ³, Jean François Peyron ⁴, Dorota Czerucka ⁴, Faredj Cherikh ⁵, Jérôme Filippi ³, Albert Tran ³ and Xavier Hébuterne ³

¹ Hôpital de ’Archet and Unité INSERM 526, France
² Hôpital Pasteur, France
³ Hôpital de ’Archet and Unité, France
⁴ INSERM 526, France
⁵ Hôpital de ’Archet and Unité and Psychiatry of liaison, France

^* To whom correspondence should be addressed. E-mail: tpiche{at}fc.horus-medical.fr.

Accepted 28 November 2007

Abstract

Background: A subset of patients with the irritable bowel syndrome (IBS) has an increased number of mast cells (MCs) in the colonic mucosa. Psychological factors are believed to contribute to the course of IBS. Aims: To examine associations between fatigue, depression and MCs of the colonic mucosa in IBS.

Methods: Colonic biopsies were taken from 50 Rome II IBS patients, 21 healthy controls and 11 depressed/fatigued patients without IBS. The cellularity of the lamina propria referred as the number of inflammatory cells per high power field (hpf) through a 400x microscope. The Fatigue Impact Scale (FIS) and the short form Beck Depression Inventory (BDI) evaluated the severity of fatigue and depression.

Results: IBS had a significant increase of the cellularity of the lamina propria compared to controls or to depressed patients (94.5[48-110] vs 68[58-82] and 78[87-90] cells per hpf, p=0.005 and p=0.05 respectively), in particular of MCs (9.3[5.6-11.7] vs 4.0[2.7-6.8] and 4.3[2.8-7.8] cells per hpf, p=0.001 and p=0.005 respectively). Both FIS and BDI scores were significantly higher in IBS than in controls or in depressed patients (p<0.001). In IBS, the FIS score correlated significantly with the cellularity of the lamina propria (r=0.51, p<0.0001) and MCs (r=0.64, p<0.0001). In IBS, the BDI score correlated significantly with MCs (r=0.29, p=0.03).

Conclusions: Elevated MCs counts are a key feature of the low grade inflammatory infiltrate in the caecal mucosa of IBS. Fatigue and depression are associated with mucosal cell counts, in particular MCs suggesting that psychological factors are associated to the low-grade inflammatory infiltrate in IBS.

Keywords: Depression, Fatigue, IBS, Inflammation, Mast cell

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