scholarly journals Cross-sectional imaging of intestinal barrier dysfunction by confocal laser endomicroscopy can identify patients with food allergy in vivo with high sensitivity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Timo Rath ◽  
Walburga Dieterich ◽  
Christiane Kätscher-Murad ◽  
Markus F. Neurath ◽  
Yurdagül Zopf
Keyword(s):  
Food Allergy ◽  
Intestinal Barrier ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Epithelial Barrier ◽  
Barrier Dysfunction ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

AbstractFood allergy (FA) affects approximately 3 to 4% of the adult population in westernized countries. Suspected FA is even more prevalent and requires extensive diagnostic work-up. Within this study, we evaluated whether assessment of the integrity of the epithelial barrier by confocal laser endomicroscopy (CLE) during colonoscopy can be used as a screening tool to identify patients with FA. 60 patients with suspected FA were prospectively included. Serology with total and food-specific IgE, anti-tissue transglutaminase, skin prick testing, food intolerance tests, food intake registration and assessment of clinical complaints were performed. During colonocopy, standardized CLE was performed in the terminal ileum and at two colorectal sites. Analysis of CLE images included functional (i.e. presence of epithelial barrier dysfunction) and quantitative parameters of intestinal architecture. 27 of 60 patients (45%) were diagnosed with FA. Barrier dysfunction was analyzed on 65.837 ileal and on 93.251 colonic images. 96% of patients with FA exhibited functional and structural barrier defects while barrier dysfunction was found in only 33% of patients without FA (p < 0.0001). Visualizing barrier dysfunction with CLE for in vivo diagnosis of FA had a sensitivity and specificity of 96% and 67%, respectively, with a positive and negative prediction of 70% and 96%, respectively. Parameters intrinsic to the crypt architecture including crypt diameter, intercrypt distance, crypt lumen diameter and colonic vasculature were not different between patients with and without FA. CLE-based imaging of the intestinal barrier during colonoscopy might help in stratifying patients with suspected FA for further diagnostic work-up.

scholarly journals Expert-led didactic versus self-directed audiovisual training of confocal laser endomicroscopy in evaluation of mucosal barrier defects

2018 ◽  
Vol 06 (01) ◽  
pp. E115-E122 ◽  
Author(s):  
Roy Huynh ◽  
Matthew Ip ◽  
Jeff Chang ◽  
Craig Haifer ◽  
Rupert Leong
Keyword(s):  
The Self ◽  
Mucosal Barrier ◽  
Confocal Laser Endomicroscopy ◽  
Controlled Study ◽  
Confocal Laser ◽  
Barrier Dysfunction ◽  
Self Directed Learning ◽  
Directed Group ◽  
Endoscopy Training

Abstract Background and study aims Confocal laser endomicroscopy (CLE) allows mucosal barrier defects along the intestinal epithelium to be visualized in vivo during endoscopy. Training in CLE interpretation can be achieved didactically or through self-directed learning. This study aimed to compare the effectiveness of expert-led didactic with self-directed audiovisual teaching for training inexperienced analysts on how to recognize mucosal barrier defects on endoscope-based CLE (eCLE). Materials and methods This randomized controlled study involved trainee analysts who were taught how to recognize mucosal barrier defects on eCLE either didactically or through an audiovisual clip. After being trained, they evaluated 6 sets of 30 images. Image evaluation required the trainees to determine whether specific features of barrier dysfunction were present or not. Trainees in the didactic group engaged in peer discussion and received feedback after each set while this did not happen in the self-directed group. Accuracy, sensitivity, and specificity of both groups were compared. Results Trainees in the didactic group achieved a higher overall accuracy (87.5 % vs 85.0 %, P = 0.002) and sensitivity (84.5 % vs 80.4 %, P = 0.002) compared to trainees in the self-directed group. Interobserver agreement was higher in the didactic group (k = 0.686, 95 % CI 0.680 – 0.691, P < 0.001) than in the self-directed group (k = 0.566, 95 % CI 0.559 – 0.573, P < 0.001). Confidence (OR 6.48, 95 % CI 5.35 – 7.84, P < 0.001) and good image quality (OR 2.58, 95 % CI 2.17 – 2.82, P < 0.001) were positive predictors of accuracy. Conclusion Expert-led didactic training is more effective than self-directed audiovisual training for teaching inexperienced analysts how to recognize mucosal barrier defects on eCLE.

scholarly journals The Additional Value of Endolymphatic Hydrops Imaging With Intratympanic Contrast for Diagnostic Work-Up—Experience From a Neurotology Center in Austria

2021 ◽  
Vol 8 ◽  
Author(s):  
Lennart Weitgasser ◽  
Anna O‘Sullivan ◽  
Alexander Schlattau ◽  
Sebastian Roesch
Keyword(s):  
Endolymphatic Hydrops ◽  
Clinical Results ◽  
Resonance Imaging ◽  
Imaging Results ◽  
Diagnostic Work ◽  
Additional Value ◽  
Work Up ◽  
Quality Imaging ◽  
Diagnostic Work Up

Objective: To illustrate the merit of hydrops imaging during clinical workup of dizziness and balance disorders.Background: Ever since the first description of in-vivo endolymphatic hydrops imaging in 2007, this diagnostic tool has been implemented in an increasing number of centers. The more experience in its clinical application is gathered, the more it is possible to critically assess its potential value for the diagnostic workup. This article intends to provide information about the experience of handling and utilization of endolymphatic hydrops imaging in one of the first centers in Austria.Methods: Retrospective analysis and review of clinical cases.Results: Based on our experience of endolymphatic hydrops imaging (EHI), which was established in cooperation between our departments of radiology and otorhinolaryngology in 2017, we have exclusively used intratympanic application of a contrast agent prior to magnetic resonance imaging, as this approach provides high quality imaging results. In 42.6% of cases, EHI could lead to the diagnosis of MD or HED. Since precise vestibular examination is still necessary, EHI is not a tool to replace the clinical examination but rather to add significantly to the interpretation of the results.Conclusion: Endolymphatic hydrops imaging represents a valuable, safe and well-applicable tool for evaluating cases with inconclusive clinical results. However, its potential additional diagnostic benefits rely on a correct indication based on prior thorough vestibular investigations.

scholarly journals The Role of Atopy Patch Test in Diagnosis of Food Allergy in Atopic Eczema/Dermatitis Syndrom in Patients over 14 Years of Age

2010 ◽  
Vol 53 (2) ◽  
pp. 101-108 ◽  
Author(s):  
Jarmila Čelakovská ◽  
Jaroslava Vaněčková ◽  
Květuše Ettlerová ◽  
Karel Ettler ◽  
Josef Bukač
Keyword(s):  
Food Allergy ◽  
Atopic Eczema ◽  
Challenge Test ◽  
Food Challenge ◽  
Diagnostic Methods ◽  
Cow Milk ◽  
Patch Tests ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Few studies concerning the importance of food allergy in adolescents and adult patients with atopic eczema exist. The atopy patch tests with food have mostly been studied in infants and children since food allergy plays a role especially in this age group. Aim: The evaluation of the contribution of atopy patch tests in the diagnostic work-up of food allergy (to wheat, cow milk, peanuts, soya and eggs) in the patients with atopic eczema older than 14 years of age. Method: 120 patients were examined in the study in the diagnostic work-up of food allergy – 86 women and 34 men, the mean age 26.5 (s.d. 9.8) and the median SCORAD at the beginning of the study 32.9 (s.d. 14.0). Complete dermatological and allergological examinations in the diagnostic work-up of food allergy were performed (assessment of personal history, assessment of serum specific IgE, skin prick tests, atopy patch tests, diagnostic hypoallergenic diet, food challenge tests with egg, soy, wheat, cow milk and double – blind, placebo – controlled food challenge test with cow milk and wheat. The results of atopy patch tests were compared with the results of other diagnostic methods in the diagnosis of food allergy. Results: The food allergy to cow milk and wheat was confirmed in double – blind, placebo controlled food challenge test in few patients in our study (4 %). The suspicion of food allergy to egg is in 8 %, to peanuts in 13 % and to soya in 4 % of patients in our study. The assessment of atopy patch tests response seems to be of great importance. The reaction in atopy patch tests with more papules has the greatest diagnostic accuracy for predicting the result of challenge tests. At the beginning and at the end of diagnostic hypoallergenic diet the severity of atopic eczema/dermatitis syndrome was recorded in all patients enrolled in the study by evaluating SCORAD. The decrease of SCORAD was statistically important. Conclusion: Atopy patch tests alone cannot be used as a single test for the determination of food allergy in patients with atopic eczema/dermatitis syndrome but such a test, together with other diagnostic methods, can help to trace the food allergy.

Isoproterenol Disrupts Intestinal Barriers Activating Gut-Liver-Axis: Effects on Intestinal Mucus and Vascular Barrier as Entry Sites

Digestion ◽  
2019 ◽  
Vol 101 (6) ◽  
pp. 717-729 ◽  
Author(s):  
Marcel Sorribas ◽  
Andrea de Gottardi ◽  
Sheida Moghadamrad ◽  
Mohsin Hassan ◽  
I. Spadoni ◽  
...  
Keyword(s):  
Mononuclear Cells ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Adrenergic Stimulation ◽  
Barrier Dysfunction ◽  
Mesenteric Lymph Nodes ◽  
Ileal Loop ◽  
Mesenteric Lymph ◽  
Mucin Expression

<b><i>Background:</i></b> The gut-liver-axis presents the pathophysiological hallmark for multiple liver diseases and has been proposed to be modulated during stress and shock. Access to the gut-liver-axis needs crossing of the mucus and gut-vascular barrier. The role of β-adrenoreceptor-activation for both barriers has not been defined and is characterized here. <b><i>Methods:</i></b> Splanchnic β-adrenergic stimulation was achieved by chronic intraperitoneal application of isoproterenol via alzet-pump in vivo. The intestinal permeability and gut-vascular barrier function was assessed in ileal loop experiments. The extravasation of predefined sizes of fluorescence isothiocyanate (FITC)-dextran molecules in ileal microcirculation was evaluated by intravital confocal laser endomicroscopy in vivo. Mucus parameters thickness, goblet cell count and mucin-expression were assessed by stereomicroscopy, immunostaining and RNA-sequencing respectively. Ileal lamina propria (LP) as well as mesenteric lymph node mononuclear cells was assessed by FACS. <b><i>Results:</i></b> Healthy mice lack translocation of 4 kDa-FITC-dextran from the small intestine to the liver, whereas isoproterenol-treated mice demonstrate pathological translocation (PBT). Mucus layer is reduced in thickness with loss of goblet-cells and mucin-2-staining and -expression in isoproterenol-treated animals under standardized gnotobiotic conditions. Isoproterenol disrupts the gut vascular barrier displaying Ileal extravasation of large-sized 70- and 150 kDa-FITC-dextran. This pathological endothelial permeability and accessibility induced by isoproterenol associates with an augmented expression of plasmalemmal-vesicle-associated-protein-1 in intestinal vessel. Ileal LP after isoproterenol treatment contains more CD11c+-dendritic cells (DC) with increased appearance of CCR7+ DC in mesenteric lymph nodes. <b><i>Conclusions:</i></b> Isoproterenol impairs the intestinal muco-epithelial and endothelial-vascular barrier promoting PBT to the liver. This barrier dysfunction on multiple levels potentially can contribute to liver injury induced by catecholamines during states of increased β-adrenergic drive.

scholarly journals Food Allergy: A Rare Cause of Recurrent Intussusception

2017 ◽  
Vol 8 (1) ◽  
pp. 2 ◽  
Author(s):  
Emrah Aydin ◽  
Ömer Faruk Beşer
Keyword(s):  
Food Allergy ◽  
Diagnostic Work ◽  
Recurrent Intussusception ◽  
Work Up ◽  
Diagnostic Work Up

Recurrent intussusception is a management dilemma and have many causes. We report a 22-month old boy who presented multiple times for recurrent intussusception. At diagnostic work-up he was found to be suffering from non-IgE food allergy. The child did not develop further episodes of intussusception after removal of allergenic diet.

Confocal Laser Endomicroscopy in the Evaluation of Inflammatory Bowel Disease

2019 ◽  
Vol 25 (8) ◽  
pp. 1302-1312
Author(s):  
Anna M Buchner
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Intestinal Barrier ◽  
Mucosal Healing ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Endoscopic Evaluation ◽  
Real Time Visualization ◽  
Inflammatory Bowel

Abstract Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, can be effectively monitored with the use of endoscopy. The additional application of small field imaging technology such as confocal laser endomicroscopy CLE during ongoing endoscopic evaluation has led to real-time visualization of mucosal abnormalities and thus in vivo histology. The endomicroscopy (CLE) can improve IBD endoscopic evaluation by identifying seemingly normal-appearing mucosa, assessing the function of the intestinal barrier of the epithelium and vascular permeability, and by characterizing any mucosal lesions, including dysplastic lesions. CLE used during conventional endoscopy could especially facilitate the evaluation of mucosal healing in IBD. In addition, future developments in molecular imaging in IBD may optimize therapeutic approaches by identifying mucosal targets for therapy and determining the reasons for lack of response to specific therapy or subsequent loss of the response.

scholarly journals Tryptophan, glutamine, leucine, and micronutrient supplementation improves environmental enteropathy in Zambian adults: a randomized controlled trial

2019 ◽  
Vol 110 (5) ◽  
pp. 1240-1252 ◽  
Author(s):  
John Louis-Auguste ◽  
Ellen Besa ◽  
Kanekwa Zyambo ◽  
Derick Munkombwe ◽  
Rosemary Banda ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Microbial Translocation ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Residential Areas ◽  
Barrier Dysfunction ◽  
Randomized Controlled ◽  
Environmental Enteropathy

ABSTRACT Background Environmental enteropathy (EE) refers to villus blunting, reduced absorption, and microbial translocation in children and adults in tropical or deprived residential areas. In previous work we observed an effect of micronutrients on villus height (VH). Objective We aimed to determine, in a randomized controlled trial, if amino acid (AA) or multiple micronutrient (MM) supplementation can improve intestinal structure or barrier dysfunction in Zambian adults with EE. Methods AA (tryptophan, leucine, and glutamine) and/or MM supplements were given for 16 wk in a 2 × 2 factorial comparison against placebo. Primary outcomes were changes in VH, in vivo small intestinal barrier dysfunction assessed by confocal laser endomicroscopy (CLE), and mechanistic (or mammalian) target of rapamycin complex 1 (MTORC1) nutrient responsiveness in lamina propria CD4+ lymphocytes. Results Over 16 wk AA, but not MM, supplementation increased VH by 16% (34.5 μm) compared with placebo (P = 0.04). Fluorescein leak, measured by CLE, improved only in those allocated to both AA and MM supplementation. No effect was seen on MTORC1 activation, but posttreatment MTORC1 and VH were correlated (ρ = 0.51; P = 0.001), and change in MTORC1 was correlated with change in VH in the placebo group (ρ = 0.63; P = 0.03). In secondary analyses no effect was observed on biomarkers of microbial translocation. Metabolomic analyses suggest alterations in a number of microbial- and host-derived metabolites including the leucine metabolite β-hydroxy-β-methylbutyrate, which was increased by AA supplementation and correlated with VH. Conclusions In this phase 2 trial, AA supplementation protected against a decline in VH over the supplementation period, and improved barrier function when combined with micronutrients. Leucine and MTORC1 metabolism may be involved in the mechanism of effect. This trial was registered at www.pactr.org as PACTR201505001104412.

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