Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome

Abstract

Background and aims: Post-dysenteric irritable bowel syndrome (PD-IBS) develops in up to 25% of patients following Campylobacter enteritis. Our aim was to define the pathological basis of this subgroup of IBS.

Methods: Twenty one patients (group 1) underwent serial rectal biopsy and gut permeability testing following acute Campylobacter enteritis as did 10 PD-IBS patients (group 2) and 12 asymptomatic controls.

Results: In group 1, enteroendocrine cell (EC) numbers were markedly increased initially and at six and 12 weeks (p<0.001) compared with controls. Gut permeability, as assessed by the lactulose/mannitol ratio, was significantly elevated, initially and at 12 weeks (p<0.005). CD3, CD4, and CD8 lymphocyte counts in the lamina propria and intraepithelial lymphocytes (IEL) were significantly increased initially compared with controls. At visit 1, EC numbers were positively correlated with CD3 counts (r=0.6, p=0.01). At one year, seven subjects (five with persistent loose stools) had rectal biopsies which showed significantly elevated EC, CD3, and IEL counts. In group 2, EC and IEL counts were significantly increased compared with controls (p<0.001), as was gut permeability (p<0.01).

Conclusion: Increased EC, T lymphocytes, and gut permeability are acute changes following Campylobacter enteritis which can persist for more than a year and may contribute to PD-IBS.

Figures

Figure 1

(A) Enteroendocrine cell counts per 100 epithelial cells in the patient cohort at visits 1, 2, and 3 compared with controls and post-dysenteric irritable bowel syndrome (PD-IBS) patients. ***Significantly increased compared with controls, p

Figure 1

(A) Enteroendocrine cell counts per 100 epithelial cells in the patient cohort at visits 1, 2, and 3 compared with controls and post-dysenteric irritable bowel syndrome (PD-IBS) patients. ***Significantly increased compared with controls, p

Figure 2

CD3 staining lamina propria lymphocytes. ***p

Figure 3

Intraepithelial lymphocytes stained for the CD8 marker. **Significantly elevated compared with controls. Differences from control were no longer significant at visits 2 and 3. Post-dysenteric irritable bowel syndrome (PD-IBS) patients also showed significant increases.

Figure 4

Macrophages counts (CD68 positive) showed a marked decline at visit 1. ***p