Gastroenterology

Gastroenterology

Volume 123, Issue 6, December 2002, Pages 1972-1979
Gastroenterology

Basic–Alimentary Tract
Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome,☆☆

https://doi.org/10.1053/gast.2002.37059Get rights and content

Abstract

Background & Aims: Irritable bowel syndrome (IBS) is regarded as a functional bowel disorder. Few studies have looked for histopathologic changes in the gut and only then in biopsy specimens from intestinal mucosa. Because bowel function is governed mainly by nerve plexuses in the bowel wall, we have investigated full-thickness bowel biopsy specimens in patients with severe IBS. Methods: We used a laparoscopy-assisted technique to obtain full-thickness biopsy specimens from the proximal jejunum. Tissue specimens were investigated with light microscopy using routine stainings and immunohistochemical techniques. Horizontal sectioning was done to visualize large areas of the myenteric plexus. Fifteen autopsy specimens were used as controls regarding the myenteric plexus. Colorectal adenoma controls with terminal ileum biopsy specimens and full-thickness jejunal biopsy specimens from patients with degenerative enteric neuropathy were used as control groups for intraepithelial lymphocyte counts. Results: Ten patients (2 males, 8 females) were studied. In 9 patients, we found low-grade infiltration of lymphocytes in the myenteric plexus. Lymphocytes had peri- and intraganglionic location. The mean number of lymphocytes per ganglion ranged from 1.9 to 7.1 per patient, with an overall mean of 3.4. No intraganglionic lymphocytes were found in the control group and only a few periganglionic lymphocytes (mean, 0.2). Four patients had concomitant intraepithelial lymphocytosis. Neuron degeneration was evident in 6 of 9 patients with and 1 patient without ganglionic lymphocyte infiltration. Conclusions: Our findings indicate that inflammation and neuronal degeneration in the myenteric plexus are involved in the pathogenesis of IBS.

GASTROENTEROLOGY 2002;123:1972-1979

Section snippets

Patient selection

Consecutive patients who met the inclusion criteria and agreed to participate were included in the study between 1998 and 1999. All patients were seen at the Department of Gastroenterology and Hepatology, Huddinge University Hospital, Stockholm, Sweden. The inclusion criteria were the following: (1) fulfillment of the Rome-I Criteria for the Diagnosis of IBS, (2) need for referral to a specialist in gastroenterology, (3) sick listing from work because of IBS symptoms for more than 1 month

Results

Eight women and 2 men with severe IBS were studied. The average age was 40 years (range, 23–57 years). All patients underwent laparoscopy-assisted full-thickness biopsy of the jejunum from which the patient-related results below were obtained. The postoperative period was uneventful, and all patients were discharged on the first postoperative day. Brief patient characteristics were as follows:

  • Female 45 years of age, constipation-predominant IBS. Dyspeptic symptoms during many years. Developed

Discussion

The results of our study must be interpreted with caution. We found histopathologic abnormalities of the proximal jejunum in patients whose diagnosis was based on the absence of structural lesions and fulfilling the Rome I criteria for IBS. The patients were from different age groups and could be divided into all categories of IBS. There were coexisting diseases in the group but nothing that interferes with the IBS diagnosis and, most importantly, that can explain our findings. We observed 5

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  • Cited by (0)

    Address requests for reprints to: Hans Törnblom, M.D., Karolinska Institutet Department of Medicine at Huddinge University Hospital, Division of Gastroenterology and Hepatology, K63 SE-141 86 Huddinge, Sweden. e-mail: [email protected]; fax: (46) 8 585 823 35.

    ☆☆

    Supported by a research grant from the Swedish Society of Medicine (Bengt Ihres fond).

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