Gastroenterology

Gastroenterology

Volume 125, Issue 6, December 2003, Pages 1651-1659
Gastroenterology

Clinical-alimentary tract
Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS

https://doi.org/10.1053/j.gastro.2003.09.028Get rights and content

Abstract

Background & Aims: Both psychological and mucosal changes (increased enterochromaffin [EC] cells and T lymphocytes) have been associated with postinfectious irritable bowel syndrome (PI-IBS). However, previous studies have been underpowered to determine the relative importance of these changes in predicting the development of PI-IBS. Our aim was to prospectively determine the relative importance of both psychological and histologic factors in the development of PI-IBS after Campylobacter infection. Methods: Questionnaires detailing psychological and bowel symptoms were sent to 1977 patients 3 months after infection. Twenty-eight patients with new-onset PI-IBS, 28 age- and sex-matched patient controls who were asymptomatic after infection, and 34 healthy volunteers underwent rectal biopsy, which was assessed for serotonin-containing EC cells, mast cells, and lamina propria T lymphocytes. Results: PI-IBS, predominantly of the diarrhea-predominant subtype, occurred in 103 of 747 (13.8%) of those infected. EC cell counts per high-power field (hpf) were higher in patients with PI-IBS (35.8 ± 1.2) compared with patient controls (30.6 ± 1.9; P = 0.022) and volunteers (29.1 ± 1.8; P = 0.006). Lamina propria T lymphocytes per hpf were higher in patients with PI-IBS (127.1 ± 8.7) and patient controls (113.4 ± 6.2) in contrast to healthy volunteers (97.1 ± 5.7) (P = 0.006 and P = 0.058, respectively). Anxiety, depression, and fatigue were significantly increased in patients with PI-IBS compared with patient controls. Multivariate analysis indicated that increased EC cell counts and depression were equally important predictors of developing PI-IBS (relative risk, 3.8 and 3.2 for each standard deviation increase in respective values). Conclusions: Both increased EC cells and depression are important independent predictors of developing PI-IBS.

Section snippets

Subjects

Between September 1999 and July 2002, a total of 1977 questionnaires detailing the acute symptoms of gastroenteritis as well as current and previous bowel habit were sent to all subjects aged 18–75 years 3 months after a positive stool culture for Campylobacter jejuni or Campylobacter coli within the Nottingham Health Authority area. Those who responded and recorded new IBS symptoms in accordance with the Rome I criteria11 were invited to take part (PI-IBS, group 1). Our control patients (group

Patients

A total of 840 questionnaires of 1977 (42%) were returned, of which 93 were excluded for the following reasons: preexisting IBS, 46; incomplete, 38; inflammatory bowel disease, 3; liver transplant, 1; chronic pancreatitis, 1; multiple bowel operations, 1; feeding gastrostomy, 1; lymphoma, 1; dead, 1. A total of 103 (13.8%) of the 747 evaluable questionnaires fulfilled the Rome I criteria for developing new symptoms of IBS after Campylobacter infection. Of the 103 subjects, only 54 could be

Discussion

There is increasing evidence that bowel inflammation within the mucosa, myenteric plexus, and smooth muscle is associated with functional bowel disorders. A number of investigators have reported elevated numbers of inflammatory cells and mast cells in mucosal biopsy specimens in IBS,5, 21, 22, 23, 24 and laparoscopic full-thickness biopsy specimens of the jejunum have shown inflammation and neuronal degeneration in the myenteric plexus of particularly severely affected patients with IBS.25

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