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Colonic immune cells in irritable bowel syndrome: A systematic review and meta-analysis
M Bashashati1, S Moossavi2,3, C Cremon4
1Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
Insights
Irritable Bowel Syndrome (IBS) patients show increased mast cells and CD3+ T cells in colonic biopsies. These immune cell changes are segmental and may vary by IBS subtype, warranting further diagnostic investigation.
Area of Science:
- Gastroenterology
- Immunology
- Microbiome Research
Background:
- Irritable Bowel Syndrome (IBS) is associated with increased mucosal immune cells, but findings vary.
- Methodological differences and small sample sizes may explain inconsistencies in previous studies.
Purpose of the Study:
- To conduct a meta-analysis of case-control studies on colonic immune cell counts in IBS patients versus controls.
- To clarify the role of specific immune cells in IBS pathogenesis.
Main Methods:
- Searched PubMed and Embase databases in February 2017.
- Pooled results using standardized mean difference (SMD) with fixed or random effect models based on heterogeneity (I² statistics).
- Analyzed immune cell counts in colonic biopsies from IBS patients and healthy controls.
Main Results:
- Included 22 studies with 706 IBS patients and 401 controls.
- Found increased mast cells in the rectosigmoid and descending colon of IBS patients (P < .05).
- Observed increased CD3+ T cells in the rectosigmoid and descending colon, potentially linked to higher CD4+ T cells (P < .05).
Conclusions:
- Mast cells and CD3+ T cells are elevated in colonic biopsies of IBS patients compared to controls.
- Immune cell increases are segmental and can be IBS-subtype dependent.
- Further research is needed to determine the diagnostic value of colonic mucosal cell quantification in IBS.
Background & Aims:
Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between studies, possibly due to a combination of methodological variability, population differences and small sample sizes. We performed a meta-analysis of case-control studies that compared immune cell counts in colonic biopsies of IBS patients and controls.
Methods:
PubMed and Embase were searched in February 2017. Results were pooled using standardized mean difference (SMD) and were considered significant when zero was not within the 95% confidence interval (CI). Heterogeneity was assessed based on I2 statistics where I2 ≤ 50% and I2 > 50% indicated fixed and random effect models, respectively.
Key Results:
Twenty-two studies on 706 IBS patients and 401 controls were included. Mast cells were increased in the rectosigmoid (SMD: 0.38 [95% CI: 0.06-0.71]; P = .02) and descending colon (SMD: 1.69 [95% CI: 0.65-2.73]; P = .001) of IBS patients. Increased mast cells were observed in both constipation (IBS-C) and diarrhea predominant IBS (IBS-D). CD3+ T cells were increased in the rectosigmoid (SMD: 0.53 [95% CI: 0.21-0.85]; P = .001) and the descending colon of the IBS patients (SMD: 0.79, 95% CI [0.28-1.30]; P = .002). This was possibly in relation to higher CD4+ T cells in IBS (SMD: 0.33 [95% CI: 0.01-0.65]; P = .04) as there were no differences in CD8+ T cells.
Conclusions & Inferences:
Mast cells and CD3+ T cells are increased in colonic biopsies of patients with IBS vs non-inflamed controls. These changes are segmental and sometimes IBS-subtype dependent. The diagnostic value of the quantification of colonic mucosal cells in IBS requires further investigation.
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