Alterations in Intestinal Mucosal Barrier Visualized by Confocal Laser Endomicroscopy in Liver Cirrhosis: a Pilot Trial (AMBIC)

The pathogenesis of inflammatory bowel disease (IBD) is multifactorial with data suggesting the role of a disturbed interaction between the gut and the intestinal microbiota. A defective mucosal barrier may result in increased intestinal permeability which promotes the exposition to luminal content and triggers an immunological response that promotes intestinal inflammation. IBD patients display several defects in the many specialized components of mucosal barrier, from the mucus layer composition to the adhesion molecules that regulate paracellular permeability. These alterations may represent a primary dysfunction in Crohn’s disease, but they may also perpetuate chronic mucosal inflammation in ulcerative colitis. In clinical practice, several studies have documented that changes in intestinal permeability can predict IBD course. Functional tests, such as the sugar absorption tests or the novel imaging technique using confocal laser endomicroscopy, allow anin vivoassessment of gut barrier integrity. Antitumor necrosis factor-α(TNF-α) therapy reduces mucosal inflammation and restores intestinal permeability in IBD patients. Butyrate, zinc, and some probiotics also ameliorate mucosal barrier dysfunction but their use is still limited and further studies are needed before considering permeability manipulation as a therapeutic target in IBD.

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The learning curve, interobserver, and intraobserver agreement of endoscopic confocal laser endomicroscopy in the assessment of mucosal barrier defects

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.08.045 ◽

2016 ◽

Vol 83 (4) ◽

pp. 785-791.e1 ◽

Cited By ~ 12

Author(s):

Jeff Chang ◽

Matthew Ip ◽

Michael Yang ◽

Brendon Wong ◽

Theresa Power ◽

...

Keyword(s):

Learning Curve ◽

Mucosal Barrier ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Intraobserver Agreement

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Tu1566 Confocal LASER Endomicroscopy (CLE) for In Vivo Assessment of Portal Hypertensive Colopathy and Clinical Outcome of Patients With Liver Cirrhosis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.02.1012 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB588

Author(s):

Helmut Neumann ◽

Gian Eugenio Tontini ◽

Michael Vieth ◽

YurdagüL. Zopf ◽

Markus F. Neurath ◽

...

Keyword(s):

Liver Cirrhosis ◽

Clinical Outcome ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

In Vivo Assessment

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

Endoscopy International Open ◽

10.1055/s-0043-114664 ◽

2018 ◽

Vol 06 (01) ◽

pp. E115-E122 ◽

Cited By ~ 2

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.

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Adaptation of the small intestine to microbial enteropathogens in Zambian children with stunting

Nature Microbiology ◽

10.1038/s41564-020-00849-w ◽

2021 ◽

Vol 6 (4) ◽

pp. 445-454 ◽

Cited By ~ 2

Author(s):

Beatrice Amadi ◽

Kanekwa Zyambo ◽

Kanta Chandwe ◽

Ellen Besa ◽

Chola Mulenga ◽

...

Keyword(s):

Microbial Translocation ◽

Nutritional Supplementation ◽

Mucosal Barrier ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Good Growth ◽

Epithelial Surface ◽

Epithelial Damage ◽

Environmental Enteropathy ◽

Brush Border Enzyme

AbstractEnvironmental enteropathy is a major contributor to growth faltering in millions of children in Africa and South Asia. We carried out a longitudinal, observational and interventional study in Lusaka, Zambia, of 297 children with stunting (aged 2–17 months at recruitment) and 46 control children who had good growth (aged 1–5 months at recruitment). Control children contributed data only at baseline. Children were provided with nutritional supplementation of daily cornmeal-soy blend, an egg and a micronutrient sprinkle, and were followed up to 24 months of age. Children whose growth did not improve over 4–6 months of nutritional supplementation were classified as having non-responsive stunting. We monitored microbial translocation from the gut lumen to the bloodstream in the cohort with non-responsive stunting (n = 108) by measuring circulating lipopolysaccharide (LPS), LPS-binding protein and soluble CD14 at baseline and when non-response was declared. We found that microbial translocation decreased with increasing age, such that LPS declined in 81 (75%) of 108 children with non-responsive stunting, despite sustained pathogen pressure and ongoing intestinal epithelial damage. We used confocal laser endomicroscopy and found that mucosal leakiness also declined with age. However, expression of brush border enzyme, nutrient transporter and mucosal barrier genes in intestinal biopsies did not change with age or correlate with biomarkers of microbial translocation. We propose that environmental enteropathy arises through adaptation to pathogen-mediated epithelial damage. Although environmental enteropathy reduces microbial translocation, it does so at the cost of impaired growth. The reduced epithelial surface area imposed by villus blunting may explain these findings.

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