Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acuteCampylobacter enteritis and in post-dysenteric irritable bowel syndrome
- aDivision of Gastroenterology, University Hospital Nottingham, Nottingham, UK, bDepartment of Pathology, University Hospital Nottingham, Nottingham, UK, cDepartment of Public Health Medicine, University Hospital Nottingham, Nottingham, UK
- Dr R C Spiller, Division of Gastroenterology, C Floor, South Block, University Hospital, Nottingham NG7 2UH, UK.
- Accepted 22 June 2000
BACKGROUND AND AIMS Post-dysenteric irritable bowel syndrome (PD-IBS) develops in up to 25% of patients followingCampylobacter enteritis. Our aim was to define the pathological basis of this subgroup of IBS.
METHODS Twenty one patients (group 1) underwent serial rectal biopsy and gut permeability testing following acute Campylobacterenteritis as did 10 PD-IBS patients (group 2) and 12 asymptomatic controls.
RESULTS In group 1, enteroendocrine cell (EC) numbers were markedly increased initially and at six and 12 weeks (p<0.001) compared with controls. Gut permeability, as assessed by the lactulose/mannitol ratio, was significantly elevated, initially and at 12 weeks (p<0.005). CD3, CD4, and CD8 lymphocyte counts in the lamina propria and intraepithelial lymphocytes (IEL) were significantly increased initially compared with controls. At visit 1, EC numbers were positively correlated with CD3 counts (r=0.6, p=0.01). At one year, seven subjects (five with persistent loose stools) had rectal biopsies which showed significantly elevated EC, CD3, and IEL counts. In group 2, EC and IEL counts were significantly increased compared with controls (p<0.001), as was gut permeability (p<0.01).
CONCLUSION Increased EC, T lymphocytes, and gut permeability are acute changes followingCampylobacter enteritis which can persist for more than a year and may contribute to PD-IBS.
- Abbreviations used in this paper:
- post-dysenteric irritable bowel syndrome
- enteroendocrine cell
- intraepithelial lymphocyte
- 3′3 diaminobenzidine tetrahydrochloride
- peptide YY