Comparative evaluation of Inflammatory cells and Interleukins in Irritable Bowel Syndrome subtypes

Abstract

Background: Irritable Bowel syndrome is a  gastrointestinal  disorder with a high prevalence but its etiopathogenesis is not very clear. In recent years role of immunogenic activation as one of the  causative factors  has gained acceptance. This study was undertaken to analyse the difference between patients presenting predominantly with diarrhoea [IBS-D] and those with predominant constipation [IBS-C] with respect to immune cells [CD3 , CD8 Intraepithelial lymphocytes (IELs) and Mast cells] and the  cytokine profile assay as well as to assess the correlation between  the  immune cells and the cytokine levels.Methods: Fifty one clinically diagnosed IBS patients and twenty three healthy controls were included. IBS patients were further subgrouped into IBS-D and IBS-C based on predominant stool pattern. Biopsies from descending colon were taken after detailed clinical history and thorough full length colonoscopy.  IHC for CD3, CD8 IELs and Mast cells was done and counts were given. Simultaneously Interleukins levels were assayed by ELISA. Results:Mean (SD) values of both CD 3 and CD8 +ve IELs  and Mast cell counts were higher  in IBS-D  subgroup  compared to  IBS-C subgroup. However the difference between  these two groups  was found to be  statistically significant for mast cells only.Level of IL-2, IL-6 and IL-8 were significantly high   in  both IBS- D and IBS C subgroups as compared to controls. On comparing  the two subgroups,  only IL8 showed a significant difference between the two.  The increase in mast cells correlated positively with CD3 lymphocytes and IL-8. Conclusion: Inflammation has a significant role  in the causation of IBS along with psychological disorders. We also advocate different treatment strategies for IBS-D and IBS-C patients as they show different levels of expression of immune cells and  inflammatory cytokines