Gastrointestinal adverse reaction to food (GARF) and endoscopic confocal laser endomicroscopy (eCLE)

Abstract

Background and study aims Gastrointestinal adverse reaction to food (GARF) is reported frequently in the general population and even more in patients with disorders of the gut brain axis. However, there is a significant difference between self-reported and objective proven GARF. The aim of the study was to characterize a mucosal correlate of GARF by endoscopic confocal laser endomicroscopy (eCLE) with duodenal food challenge (DFC).

Patients and methods In an observational and proof of concept study we evaluated 71 patients with disorders of the gut brain axis without (group I, n=19) and with (group II, n=52) GARF by eCLE and DFC. Spontaneous and food induced transfer of fluorescein into duodenal lumen was detected 10 minutes following intravenously application of fluorescein and 10 minutes after DFC.

Results According to Rom IV, the patients (group I/II) could be classified as irritable bowel syndrome (IBS) 32%/31%, functional abdominal pain without changes in bowel movement 47 %/48 %, functional abdominal bloating/distension 0 %/10 %, functional diarrhea 5 %/ 2 %, and unspecified functional bowel disorder 16 %/10 %, respectively. 21 %/27 % of the patients responded with a fluorescein leakage into the duodenal lumen before and 74 %/69 % following to DFC. Frequency rank order of food components that induced a response were soy (55.5 %/60 %), wheat (60 %/45.5 %), egg (35.7 %/8.3), milk (30 %/18.2 %) and yeast (10 %/6.6 %), respectively. Histology of duodenal biopsies, number, form and distribution of intraepithelial lymphocytes and mucosal mast cells as well as mast cell function were normal. Overall, 14 %/79 % reported main symptom benefit following a food exclusion therapy according to eCLE and DFC that was significant different between the groups.

Conclusion The results of our study indicate that eCLE with DFC is a technique to clinically evaluate patients with disorders of the gut brain axis and GARF resulting in a high proportion of patients reporting symptom benefit upon food exclusion dietary advice focussed on the results of eCLE.

Zusammenfassung

Hintergrund und Studienziel Gastrointestinale Nahrungsunverträglichkeiten (GARF) werden häufig in der Allgemeinbevölkerung und insbesondere bei Patienten mit Störungen der Darm Hirn Achse berichtet. Allerdings besteht eine große Diskrepanz zwischen der subjektiv empfundenen und der objektivierten GARF. Das Studienziel war die Charakterisierung eines mukosalen Korrelates durch die duodenale Nahrungsprovokation (DFC) mittels endoskopischer konfokaler Laserendomikroskopie (eCLE).

Patienten und Methode In einer Observations- und „proof of concept“-Studie wurden 71 Patienten mit Störungen der Darm Hirn Achse ohne (Gruppe I, n=19) und mit (Gruppe II, n=52) GARF durch eCLE und DFC untersucht. Hierbei wurden der spontane und nahrungsinduzierte Transfer von Fluorescein in das Duodenallumen 10 Minuten nach intravenöser Gabe untersucht.

Ergebnisse Die Patienten (Gruppe I/II) wurden gemäß Rom IV-Kriterien in Reizdarmsyndrom (IBS) 32%/31%, funktionelle Bauchschmerzen ohne Stuhlgangverändeurngen 47%/48%, funktionelle Blähungen/Bauchdistension 0%/10%, funktionelle Diarrhoe 5%/ 2%, and unspezifische funktionelle Bauchbeschwerden 16%/10% klassifiziert. 21%/27% der Patienten zeigten einen Transfer von Fluorescein in das Duodenallumen vor und 74%/69% nach DFC. Die Häufigkeitsrangfolge der Nahrungskomponenten, die eine Reaktion auslösten, waren Soja (55,5%/60%), Weizen (60%/45,5%), Ei (35,7%/8,3%), Milch (30%/18,2%) und Hefe (10%/6,6%). Sowohl die Histologie der Duodenalbiopsien, die Zahl, Form und Verteilung der intraepithelialen Lymphozyten und Mastzellen als auch die Funktion der Mastzellen waren unauffällig. Insgesamt berichteten 14%/79% über eine Symptomenbesserung durch eine diätetische Ausschlusstherapie gemäß den Ergebnissen der DFC, die zwischen den beiden Gruppen nicht signifikant unterschiedlich war.

Schlussfolgerung Die Ergebnisse der Studie zeigen, dass eCLE mit DFC eine Technik zur Untersuchung von Patienten mit Störungen der Darm Hirn Achse und GARF ist. Hierdurch kann eine große Gruppe von Patienten charakterisiert werden, die von einer diätetischen Auschlusstherapie gemäß den Ergebnissen der eCLE profitieren.

Keywords

Endoscopic confocal laser endomicroscopy (eCLE) - gastrointestinal adverse reaction to food (GARF) - food intolerance - functional abdominal pain - irritable bowel syndrome (IBS) - disorders of gut brain axis - intestinal permeability

Schlüsselwörter

Endoskopische konfokale Laserendomikroskopie (eCLE) - gastrointestinale adverse Reaktion auf Nahrung (GARF) - Nahrungsunverträglichkeit - funktionelle Bauchschmerzen - Reizdarmsyndrom (IBS) - Störungen der Darm Hirn Achse - intestinale Permeabilität

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