Prospective, double-blind diagnostic study of confocal laser endomicroscopy (CLE) for wheat sensitivity (WS) in patients with irritable bowel syndrome
Final Report Abstract
In the present study coordinated by the Medical Clinic for Gastroenterology, Infectiology and Rheumatology at the Charité – Universitätsmedizin Berlin investigated whether a novel procedure – confocal laser endomicroscopy – can predict wheat sensitivity in patients with the irritable bowel syndrome. The irritable bowel syndrome is characterized by chronic abdominal pain, abnormal stool pattern and bloating, and affects about 12% of the population in Northern Europe. By confocal laser endomicroscopy we looked for changes in the small intestine after instillation of wheat and other nutrients. Afterwards patients followed a gluten-free diet for 8 weeks and there symptoms were monitored by weekly telephone interviews. Overall 147 patients with the irritable bowel syndrome participated at the study centers in Berlin, Jena, Kiel, and Wiesbaden. 1) Symptoms improved considerably in more than half (57%) of the patients with irritable bowel syndrome following a gluten-free diet for two months. These patients where thus classified as wheat-sensitive. 2) Confocal laser endomicroscopy revealed a small intestine reaction to wheat in 46% of the patients; 22% of the patients reacted to yeast, 18% to soy, and 12% to milk protein. 3) Of the patients who reacted to wheat in confocal laser endomicroscoy, about two thirds (68%) showed clear improvement of irritable bowel syndrome symptoms after two months of glutenfree diet, however, about one third did not improve. Conversely, almost half (49%) of the patients who did not react to wheat in confocal endomicroscopy, nonetheless showed clear improvement of irritable bowel syndrome symptoms after two months of gluten-free diet. Overall, the diagnostic accuracy of confocal laser endomicroscopy for wheat sensitivity is therefore insufficient.
Publications
- Prospective, double-blind diagnostic multicenter study of confocal laser endomicroscopy for wheat sensitivity in patients with irritable bowel syndrome Gut 2021, 0:1–9
Bojarski C, Tangermann P, Barmeyer C, Buchkremer J, Ellrichmann M, Schreiber S, Schmidt C, Stallmach A, Kiesslich R, Röhle R, Loddenkemper C, Daum S, Siegmund B, Schumann M, Ullrich R
(See online at https://doi.org/10.1136/gutjnl-2021-325181)
