Biomarkers to assess an anti-inflammatory treatment for irritable bowel syndrome: mast cell assays and magnetic resonance imaging

Lam, Ching Yin (2015) Biomarkers to assess an anti-inflammatory treatment for irritable bowel syndrome: mast cell assays and magnetic resonance imaging. PhD thesis, University of Nottingham.

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Irritable bowel syndrome (IBS) remains a heterogeneous condition and is a common condition. The causes of IBS remain poorly understood and there is a lack in biomarkers to distinguish this condition.

Recently, there have been reports on the release of immune mediators leading to symptoms of irritable bowel syndrome. Mast cells, which can be activated by allergy or stress, are thought to be important cause of symptoms in some IBS patients because they can release chemicals, which cause pain and diarrhoea. Currently, there are few effective treatments available to alleviate these symptoms. Recent small studies have shown that Mesalazine, an ‘anti-inflammatory’ drug, may be able to modify and reverse the symptoms of IBS with diarrhoea. One small study suggested Mesalazine reduced mast cell numbers. This current study is one of the largest studies looking at the use of Mesalazine as a form of treatment for IBS with diarrhoea. Unfortunately, this study did not show any beneficial effect of Mesalazine treatment in unselected patients with IBS and diarrhoea. Potentially, there is a subgroup of IBS patients who developed their symptoms following a bout of gastroenteritis who appeared to benefit from Mesalazine treatment but a larger study is needed to confirm this. In this study, the mast cell mediators released from mucosal biopsies was not a useful marker of disease since it failed to correlate with any symptoms.

Magnetic resonance imaging (MRI) is a potentially useful tool to assess the physiology of the gastrointestinal tract in patients with functional gut disorders as it does not involve radiation and is not invasive. So far, there is a lack of biomarkers to assist in diagnosis and treatment of irritable bowel syndrome. The MRI marker pill used in the multiple studies in Chapter 3 to assess whole gut transit time is very promising as it is now applied, in the research setting, to patients with chronic constipation such as slow transit constipation and irritable bowel syndrome with constipation. Further use of the MRI and adding a stimulus such as laxative in patients with chronic constipation is helpful to distinguish between functional constipation and irritable bowel syndrome with constipation; thus helping with its medical management. The use of MRI as a biomarker for diagnosis of irritable bowel syndrome remains promising although it was not demonstrated in this thesis.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Spiller, R.C.
Keywords: Irritable bowel syndrome, Magnetic resonance imaging
Subjects: W Medicine and related subjects (NLM Classification) > WI Digestive system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 28803
Depositing User: Lam, Ching
Date Deposited: 07 Jul 2016 08:04
Last Modified: 14 Oct 2017 09:31

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