Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(01): E67-E71
DOI: 10.1055/a-1978-6753
Original article

Food intolerance in patients with functional abdominal pain: Evaluation through endoscopic confocal laser endomicroscopy

Besmir Gjini
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
,
Ilka Melchior
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
,
Philipp Euler
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
,
Christian Kreysel
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
,
Sigrid Kalde
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
,
Britta Krummen
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
,
Ralf Kiesslich
2   Department of Internal Medicine and Gastroenterology, Helios Clinic Wiesbaden, Germany
,
Bernhard Hemmerlein
3   Department of Pathology, Helios Clinic Krefeld, Germany
,
Thomas Frieling
1   Department of Internal Medicine and Gastroenterology, Helios Clinic Krefeld, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Gastrointestinal symptoms assumed to be caused by food intolerance are reported frequently in the general population. There is a significant difference between self-reported and objective proven food intolerance, as shown by placebo-controlled, double-blind, randomized trials. This discrepancy may be overcome by endoscopic confocal laser endomicroscopy (eCLE).

Patients and methods In an observational study we evaluated 34 patients with functional abdominal pain and adverse reaction to food by eCLE and local duodenal food challenge for the first time. Spontaneous and food-induced transfer of fluorescein into the duodenal lumen was detected 10 minutes after intravenously application of fluorescein and 10 minutes after duodenal food challenge (DFC).

Results Of the patients, 67.6 % responded with a fluorescein leakage into the duodenal lumen. Frequency rank order of food antigens that induced a response were soy (50 %), wheat (46.1 %), milk (20 %), egg (12 %), and yeast (11.5 %), respectively. Of the patients, 23.5 % showed spontaneous leakage of fluorescein, suggesting leaky gut syndrome. Histology of duodenal biopsies and mast cell function were normal. Overall, 69.5 % of patients improved with food exclusion therapy and 13 % were symptom-free according to eCLE.

Conclusions The results of our study indicate that eCLE is a clinically useful tool to evaluate patients with functional abdominal pain and adverse reaction to food and to create individualized dietary therapy with clinical benefit for patients.



Publication History

Received: 12 July 2022

Accepted after revision: 13 October 2022

Accepted Manuscript online:
14 November 2022

Article published online:
13 January 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Turnbull L, Adams HN, Gorard DA. The diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41: 3-25
    CrossrefPubMedGoogle Scholar
  • 2 Soares RLS. Irritable bowel syndrome, food intolerance and non- celiac gluten sensitivity. A new clinical challenge. Arq Gastroenterol 2018; 55: 417-422
    PubMedGoogle Scholar
  • 3 Pasqui F, Poli C, Colecchia A. et al. Adverse food reaction and functional gastrointestinal disorders: role of the dietetic approach. J Gastrointest Liver Dis 2015; 3: 319-327
    CrossrefPubMedGoogle Scholar
  • 4 Zuberbier T, Edenharter G, Worm M. et al. Prevalence of adverse reactions to food in Germany – a population study. Allergy 2004; 59: 338-345
    CrossrefPubMedGoogle Scholar
  • 5 Lozoya-Ibáñez C, Morgado-Nunes S, Rodrigues A. et al. Prevalence and clinical features of adverse food reactions in Portuguese adults. Allergy Asthma Clin Immunol 2016; 12: 36
    CrossrefPubMedGoogle Scholar
  • 6 Fritscher-Ravens A, Schuppan D. et al. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology 2014; 147: 1012-1020
    CrossrefPubMedGoogle Scholar
  • 7 Fritscher-Ravens A, Pflaum T, Mösinger M. et al. Many patients with irritable bowel syndrome have atypical food allergies not associated with immunoglobulin E. Gastroenterology 2019; 157: 109-118
    CrossrefPubMedGoogle Scholar
  • 8 Azpiroz F, Guyonnet D, Donazzolo Y. et al. Digestive symptoms in healthy people and subjects with irritable bowel syndrome: validation of symptom frequency questionnaire. J Clin Gastroenterol 2015; 49: 2015
    CrossrefPubMedGoogle Scholar
  • 9 Lacy BE, Mearin F, Chang L. et al. Bowel disorders. Gastroenterology 2016; 150: 1393-1407
    CrossrefPubMedGoogle Scholar
  • 10 Drossman DA, Hassler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology 2016; 150: 1257-1261
    CrossrefPubMedGoogle Scholar
  • 11 Layer P, Andresen V, Allescher H. et al. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. Z Gastroenterol 2021; 59: 1323-1415
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575
    CrossrefPubMedGoogle Scholar
  • 13 Tack J, Schol J, Van den Houte K. et al. Paradigm shift: functional dyspepsia-a “leaky gut” disorder. Am J Gastroenterol 2021; 116: 274-275
    CrossrefPubMedGoogle Scholar
  • 14 Nojkov N, Zhou S-Y, Dolan RD. et al. Evidence of duodenal epithelial barrier impairment and increased pyroptosis in patients with functional dyspepsia on confocal laser endomicroscopy and “ex vivo” mucosa analysis. Am J Gastroenterol 2020; 115: 1891-1901
    CrossrefPubMedGoogle Scholar
  • 15 Vanuytsel T, van Wanrooy S, Vanheel H. et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut 2014; 63: 1293-1299
    CrossrefPubMedGoogle Scholar
  • 16 Odenwald MA, Turner JR. Intestinal permeability defects: Is it time to treat?. Clin Gastroenterol Hepatol 2013; 11: 1075-1083
    CrossrefPubMedGoogle Scholar
  • 17 Hall WL, Formanuik NL, Harnpanich D. et al. A meal enriched with soy isoflavones increases nitric oxide-mediated vasodilation in healthy postmenopausal women. J Nutr 2008; 138: 1288-1292
    CrossrefPubMedGoogle Scholar
  • 18 Yu L, Li R, Liu W. et al. Protective effects of wheat peptides against ethanol-induced gastric mucosal lesions in rats: vasodilation and anti-inflammation. Nutrients 2020; 12: 2355
    CrossrefPubMedGoogle Scholar