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Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome

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Abstract

Background

Alterations in gastrointestinal (GI) permeability and immune measures are present in some patients with irritable bowel syndrome (IBS) but the relationship to symptoms is poorly defined. In adults with IBS, we compared permeability, unstimulated peripheral blood monocyte (PBMC) interleukin-10 (IL-10) levels, IBS life interference, and GI and psychological distress symptoms.

Methods

In 88 women and 18 men with IBS, GI permeability was quantitated as percent recovery of urinary sucrose and the lactulose/mannitol (L/M) ratio. IL-10 was measured in supernatants from 72-h incubated, unstimulated PBMCs. Participants completed a 4-week daily diary recording IBS life interference on daily activities and work, IBS symptoms, and psychological distress symptoms. They also completed the Brief Symptom Inventory.

Results

The L/M ratio but not percent sucrose recovery was significantly correlated with IBS interference with activities and work and retrospectively measured anxiety and depression. Unstimulated PBMC production of IL-10 correlated significantly with IBS interference with daily work, IBS symptom score, and abdominal pain. We identified a subgroup of IBS subjects with higher IL-10 and/or higher L/M ratio who had substantially higher IBS interference and IBS symptom scores.

Conclusions

Our findings suggest a distinct subgroup of IBS patients with alterations in gut barrier function. This subgroup is characterized by increased GI permeability and/or increased PBMC production of IL-10. These physiologic alterations reflect more severe IBS as measured by interference of IBS with daily activities and daily IBS symptoms.

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Acknowledgments

This study was supported in part by R01 NR004142 and R01 NR05337 from the National Institutes of Health, the Daffy’s Foundation, the US Department of Agriculture/Agricultural Research Service (USDA/ARS) under Cooperative Agreement No. 6250-51000-043, and P30 DK56338 which funds the Texas Medical Center Digestive Disease Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work is a publication of the University of Washington and the USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital. The contents do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pediatrics, Baylor College of Medicine, Children’s Nutrition Research Center, and Texas Children’s Hospital, 1100 Bates Ave Room 8072, Houston, TX, 77030, USA

    Robert J. Shulman

  2. Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA

    Monica E. Jarrett & Margaret M. Heitkemper

  3. Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, WA, USA

    Kevin C. Cain

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Elizabeth K. Broussard

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  1. Robert J. Shulman
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Correspondence to Robert J. Shulman.

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Shulman, R.J., Jarrett, M.E., Cain, K.C. et al. Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome. J Gastroenterol 49, 1467–1476 (2014). https://doi.org/10.1007/s00535-013-0919-6

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  • DOI: https://doi.org/10.1007/s00535-013-0919-6

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