| [Background and Aims]Inflammatory bowel disease(IBD)is a chronic recurrent nonspecific intestinal inflammation,including Crohn's disease(CD)and ulcerative colitis(UC).IBD contains two periods,active and remission stage,according to the disease activity.Some IBD patients are reported to have gastrointestinal symptoms in remission,such as abdominal pain and abnormal defecation.These symptoms are similar to those are reported in irritable bowel syndrome(IBS),therefore they are called IBS-type symptoms or IBD-IBS.The etiology remains unclear.This study aims to assess the effect of clinical symptoms,psychological status,quality of life,visceral sensitivity,gut barriel function,mast cell activation and released 5-HT/NGF on IBD-IBS patients and thus to explore their roles in the visceral hypersensitivity and IBD-IBS pathophysiology.[Methods]A total of 117 IBD patients including 47 CDR patients,24 UC patients,26 IBS patients and 20 healthy controlss were enrolled from August 2017 to September 2018 in the First Affiliated Hospital of Nanjing Medical University.The clinical symptom of patients was assessed with VAS.SF-36 and IBDQ were used to evaluate the quality of life.Anxiety and depression was examined by GAD-7 and PHQ-9.Visceral sensitivity was detected by rectal balloon distention.The serum levels of 5-HT and NGF were measured by ELISA.IHC,IF,Western blot was used to detect the expression in intestinal tissues of 5-HT,NGF and MC,tight junction protein and 5-HT3R,TrkA and TRPV1,respectively.[Results]1.The prevalence of IBD-IBS:14 of 47(29.8%)CD patients in remission had IBS-type symptom.Meanwhile,12 of 24(63.16%)UC patients in remission had IBS-type symptom.2.Assessment of clinical symptom,health life quality and psychophysiology of IBD-IBS patients:The scores of VAS in CD-IBS+ and UC-IBS+ patients were higher compared to the healthy controls.The total scores of SF-36 in CD-IBS+ and UC-IBS+patients were decreased compared with IBS group and healthy controls.In addition,The scores of IBDQ and SF-36 in CD-IBS+ and UC-IBS+patients were both lower than those in the CD-IBS-group and UC-IBS-group,respectively.Compared to healthy controls,CD-IBS+ and UC-IBS+ patients had higher evaluation scores of anxiety or depression.The evaluation scores of anxiety or depression in CD-IBS+ and UC-IBS+ patients were still higher than those in the CD-IBS-patients and UC-IBS-group,respectively.Correlation analyses showed that anxiety and depression were positively associated with abdominal pain,but negatively associated with the quality of life.Meanwhile,abdominal pain had negative correlation with quality of life.3.Assessment of visceral sensitivity in IBD-IBS patients:The threshold of initial perception,defecation distress and maximum tolerance on CD-IBS+patients showed less values than those on the healthy controls.Additionally,defecation distress threshold values on CD-IBS+ patients were lower than on CD-IBS-group.In UC-IBS+ group,all these three threshold values were less than those in UC-IBS-group.Moreover,both of defecation distress threshold and maximum tolerable threshold decreased when compared to healthy controls.Three threshold values on both CD-IBS+ and UC-IBS+ groups were negatively related with abdomen pain.4.Assessment of gut barriel function in IBD-IBS patients:Weak TJ fluorescence in colonic mucosal in IBS,CD-IBS+ and UC-IBS+ groups was detected compared to healthy controls from IF assays.IF also showed a great decrease in TJ protein expression in CD-IBS+ group than in CD-IBS-group.Compared with UC-IBS-group,TJ fluorescence intensity was decreased in UC-IBS+ group.5.The role of mast cell activation and released 5-HT/NGF in visceral hypersensitivity and IBD-IBS:Expression of mast cell tryptase,5-HT and NGF increased in CD-IBS+ and UC-IBS+ patients in contrast to healthy controls,CD-IBS-and UC-IBS-patients.Serum 5-HT and NGF and mucosal 5-HT and NGF were associated with pain,visceral hypersensitivity,anxiety and depression,which were demonstrated by correlation analyses.Accordingly,the immunoreactivity of receptor proteins(5-HT3R,TrkA and TRPV1)were high in CD-IBS+ and UC-IBS+ patients.[Conclusions]1.In IBD-IBS patients,abdominal pain,anxiety,depression and visceroperception were increased and quality of life was decreased.Correlation between the four aspects indicated that psychological disorder was associated with somatic symptom,low life quality and visceral hypersensitivity.Visceral hypersensitivity and intestinal barrier dysfunction played a vital role in the pathophysiology of IBD-IBS patients.2.IBD-IBS patients showed higher expression of mast cell tryptase,5-HT,NGF,5-HT3R,TrkA and TRPV1.Both 5-HT and NGF were associated with visceral hypersensitivity.Mast cell acvtivation and released 5-HT/NGF may participate in pathophysiology of IBD-IBS through influencing visceral sensitivity.[Background and Aims]Inflammatory bowel disease(IBD)is a chronic recurrent nonspecific intestinal inflammation,including Crohn's disease(CD)and ulcerative colitis(UC).Food antigens have been shown to participate in the etiopathogenesis of inflammatory bowel disease(IBD),but their clinical value in IBD is still unclear.To analyze the levels of specific immunoglobulin G(IgG)and E(IgE)antibodies against food antigens in IBD patients and to determine their clinical value in the pathogenesis of IBD.[Methods]We performed a retrospective study based on patients who visited the First Affiliated HosPital of Nanjing Medical University between August 2016 and January 2018.A total of 137 IBD patients,including 40 patients with ulcerative colitis(UC)and 97 patients with Crohn's disease(CD),and 50 healthy controls(HCs),were recruited.Serum food-specific IgG antibodies were detected by semi-quantitative enzyme-linked immunosorbent assay,and serum food-specific IgE antibodies were measured by Western blot.The value of food-specific IgG antibodies was compared among different groups,and potent factors related to these antibodies were explored by binary logistic regression.[Results]Food-specific IgG antibodies were detected in 57.5%of UC patients,in 90.72%of CD patients and in 42%of HCs.A significantly high prevalence and titer of food-specific IgG antibodies were observed in CD patients compared to UC patients and HCs.The number of IgG-positive foods was greater in CD and UC patients than in HCs(CD vs HCs,P=0.000;UC vs HCs,P=0.029).The top five food antigens that caused positive specific IgG antibodies in CD patients were tomato(80.68%),corn(69.32%),egg(63.64%),rice(61.36%),and soybean(46.59%).The foods that caused positive specific IgG antibodies in UC patients were egg(60.87%),corn(47.83%),tomato(47.83%),rice(26.09%),and soybean(21.74%).Significantly higher levels of total food-specific IgG were detected in IBD patients treated with anti-TNF? therapy compared to patients receiving steroids and immunosuppressants(anti-TNF? vs steroids,P<0.001;anti-TNF? vs immunosuppressants,P<0.001;anti-TNF? vs steroids+ immunosuppressants,P=0.003).A decrease in food-specific IgG levels was detected in IBD patients after receiving anti-TNF? therapy(P=0.007).Patients who smoked and CD patients were prone to developing serum food-specific IgG antibodies[smoke:OR(95%CI):17.6(1.91-162.26),P=0.011;CD patients:OR(95%CI):12.48(3.45-45.09),P=0.000].There was no difference in the prevalence of food-specific IgE antibodies among CD patients(57.1%),UC patients(65.2%)and HCs(60%)(P=0.831).[Conclusions]CD patients have a higher prevalence of food-specific IgG antibodies than UC patients and HCs.IBD patients are prone to rice,corn,tomato and soybean intolerance.Smoking may be a risk factor in the occurrence of food-specific IgG antibodies.Food-specific IgG antibodies may be a potential method in the diagnosis and management of food intolerance in IBD. |
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