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Clinical and subclinical intestinal inflammation assessed by the mucosal patch technique: Studies of mucosal neutrophil and eosinophil activation in inflammatory bowel syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Inflammation)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
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2004 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 53, no 12, 1806-1812 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: There is a clear need for a rapid, simple, safe, and sensitive method of determining the type and intensity of inflammation in the gut mucosa in clinical practice. In this study, we have evaluated the potential of a new method, the mucosal patch technique, in patients with and without apparent gut inflammation, as assessed by conventional diagnostic procedures. Subjects and

METHODS: The technique tested is based on the idea that inflammatory mediators released from the rectal mucosa can be absorbed by and then extracted from cellulose patches brought into contact with the mucosa by use of an instrument with an inflatable balloon. Measurements were performed in healthy controls (n = 16) and in patients with active (n = 19) and inactive ulcerative colitis (UC, n = 8), collagen colitis (CC, n = 12), coeliac disease (n = 13), and irritable bowel syndrome (IBS, n = 13).

RESULTS: Inflammatory mediators from neutrophils (myeloperoxidase (MPO)) and eosinophils (eosinophil cationic protein (ECP)) were increased on average 300- and 10-fold, respectively, in patients with active UC compared with healthy controls and were correlated with the endoscopic score. Patients with inactive UC, CC, coeliac disease, and IBS exhibited no endoscopic signs of inflammation. These patient groups had significantly lower levels of MPO and ECP than the active UC group but showed on average a four- to sevenfold increase in MPO compared with healthy controls.

CONCLUSION: The mucosal patch technique was well tolerated by patients and easily applied by the investigator. Pronounced neutrophil and eosinophil involvement in UC was demonstrated. With the high sensitivity of the technique, low degree mucosal neutrophil activation could also be quantified in patients with CC and UC in clinical remission. The finding of increased neutrophil involvement in patients with IBS contributes to the pathophysiological ideas of this disease.

Place, publisher, year, edition, pages
2004. Vol. 53, no 12, 1806-1812 p.
Keyword [en]
Adult, Biological Markers/analysis, Eosinophil Cationic Protein/analysis, Eosinophils/*pathology, Female, Humans, Inflammation Mediators/metabolism, Inflammatory Bowel Diseases/*diagnosis/metabolism/pathology, Intestinal Mucosa/*pathology, Irritable Bowel Syndrome/*diagnosis/metabolism/pathology, Male, Middle Aged, Neutrophil Activation, Patient Compliance, Peroxidase/analysis, Rectum/metabolism, Research Support; Non-U.S. Gov't, Specimen Handling/instrumentation/methods
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93624DOI: 10.1136/gut.2003.036418PubMedID: 15542519OAI: oai:DiVA.org:uu-93624DiVA: diva2:167157
Available from: 2005-10-20 Created: 2005-10-20 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Food Antigen Sensitivity in Coeliac Disease Assessed by the Mucosal Patch Technique
Open this publication in new window or tab >>Food Antigen Sensitivity in Coeliac Disease Assessed by the Mucosal Patch Technique
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A diagnosis of coeliac disease (CD) in adults relies on the presence of a structurally abnormal intestinal mucosa, followed by a clear clinical remission on a gluten-free diet. There is a clear need for a rapid, simple, safe and sensitive method to determine the type and intensity of inflammation in the gut mucosa in clinical practice. The overall aims of our studies were to develop and evaluate a new technique, “the mucosal patch technique”, to characterize rectal local inflammatory process after rectal food challenge in patients with CD. In study 1 we evaluated the potential of the new technique. The technique was well tolerated and easily applied. Pronounced neutrophil and eosinophil involvement in ulcerative colitis (UC) was demonstrated. With the high sensitivity of the technique, low-degree mucosal neutrophil activation could also be quantified in patients with collagen colitis,UC in clinical remission and in patients with irritable bowel syndrome. In study 2 and 3 the aim was to elucidate the dynamics of the rectal inflammatory response and nitric oxide (NO) production after rectal gluten challenge. We found a pronounced neutrophil activation in coeliac patients after rectal gluten challenge. This activation was apparent 4 hours after challenge and remains for at least 48 hours. A more modest eosinophil activation started 1-2 hours later and remained at least for 48 hours. The biphasic pattern of neutrophil and eosinonphil activation after challenge suggests a biphasic inflammatory reaction. The activation of neutrophils and eosinophils precedes a pronounced enhancement of mucosal NO production. Some of our coeliac patients displayed signs of an inflammatory reaction after rectal corn gluten challenge. In study 4 the aim was to investigate the local inflammatory reaction to gluten and cow’s milk protein in CD patients in remission. The findings indicate that not only gluten sensitivity but also cow’s milk (CM) protein sensitivity is common in CD. The data support the hypothesis that CM sensitivity may contribute to persistent symptoms in coeliac patients on gluten-free diet.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 80
Keyword
Medicine, Coeliac disease, Diagnostic instrument, food hypersensitivity, gut pathophysiologi, inflammation, nitric oxide, rectal instillation, gluten, corn, milk hypersensitivity, inflammatory bowel disease, irritable bowel syndrome, Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:uu:diva-6020 (URN)91-554-6374-6 (ISBN)
Public defence
2005-11-11, Grönwallssalen, Uppsala Akademiska Sjukhus, Uppsala, 09:15
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Available from: 2005-10-20 Created: 2005-10-20Bibliographically approved

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Kristjánsson, GudjonVenge, PerLööf, Lars

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