A Study On Pathogenesis Of Irritable Bowel-like Syndrome Of Ulcerative Colitis In Remission

Part â… A study on psychological factor in the patients with ulcerative colitis in remissionBACKGROUND AND AIMS: The pathogenesis of ulcerative colitis ( UC ) has been studied intensively, but remains unclear. Genetical susceptibility,environmental factors and dysregulated immune reaction have been approved as major causes of the disease. The recent researches reported that psychological factor was associated with the exacerbation and recurrent conditions of UC in remission, and presumed that psychological factor may play a trigger role in UC , especially in irritable bowel-like syndrome during remission of the disese. The observation will investigate the effect of psychological factor and it s possible mechanism on IBLS.METHODS: Healthy controls and patients with ulcerative colitis(UC) and irritable bowel syndrome (IBS) were obtained from west china hospital during march 2004 to august 2004 in the study. UC in remission was classified into IBS (+) UC (i e IBLS) and IBS (-) UC in according withIBS symptom. A set of standard self- report and observer rating scales, including Hamilton depression (HAMD) . anxiety (HAMA) and Zung Self-Rating depression scales (SDS) . anxiety scales (SAS), were administered to analyze the general scores and presume possible mechanism ofBLS.RESULTS: The general scores of SDS. SAS. HAMA. HAMD(except cognitive disturbance and hopelessness ) in patients with IBS and IBLS compared with control group, there were significant difference (P<0.01).Whereas, there was no significant difference (P>0.05) between IBS and IBLS. The general scores of SDS. SAS. HAMA. HAMD(except cognitive disturbance and hopelessness ) in patients with active UC and IBS (-) UC groups were higher than control group, but there were no significant difference (P>0.05) .There was no significant difference (P>0.05) between UC and IBS (-) UC.CONCLUSION: There were more similar characteristics of psychological factor between IBLS and IBS, The general scores of IBS and IBLS groups were higher than control and IBS (-) UC, which suggested that anxiety and depression may be associated with IBLS. there were no definite anxiety and depression disorder in IBS (-) UC and active UC.Part IIA controlled study of colorectal mucosal monoamine neurotransmitters in patients with UC and IBSBACKGROUND AND AIMS: Negative affect(e.g, depression, anxiety and anger) is the characteristic of IBLS. More and more investigations have demonstrated that the abnormality of monoamine neurotransmitters (such as serotonin, norepinephrine and possibly dopamine) were associated with depression and anxiety, there are close relationship between negative affect and intestinal dysfunction. Whereas, the interaction among negative affect, mucosal monoamine neurotransmitters and essential processes in gut remains unknown. There was different data on intestinal mucosal serotonin, norepinephrine content abroad,but none could be searched from Chinese literatures. In this experiment, we detected intestinal mucosal serotonin, norepinephrine levels in IBS and UC , in order to explore the possible pathogenesis of monoamine neurotransmitters in IBLS.METHODS: Colorectal biopsy specimens were obtained from healthy controls and patients with UC and IBS. The gut mucosal NE and 5-HT levels were measured by high performance liquid chromatography with electrochemical detection (HPLC-ECD).ESULTS: (1) The gut mucosal NE and 5-HT contents of IBS and control groups was higher than UC group, the mucosal NE and 5-HT content of control group was the highest than other groups. (2) the gut mucosal 5-HT content of active UC was the lowest in all groups, there was no significantdifference between IBLS and control group (P>0.05). (3) the gut mucosal NE content of IBLS was the lowest than other groups, whereas, there was no significant difference between IBS (-) UC and IBLS group (P>0.05). (4) The gut mucosal NE and 5-HT content of UC was lower than control or IBS group.CONCLUSION: (1) The gut mucosal NE and 5-HT contents of IBS was lower than control group, and higher than UC groups,which indicate gut mucosal NE and 5-HT contents (especially the alteration of mucosal 5-HT) were associated with intestinal inflammation. (2 ) There was a similarity of mucosal 5-HT content between IBLS and IBS and NE content between IBLS and UC,IBLS might share the pathogenesis in common with IBS and UC.Part ElAlteration of intestinal mast cells and enterochromaffin cells in patients with ulcerative colitis and irritable bowel syndromeBACKGROUND AND AIMS: Ulcerative colitis is prominently associated with Th2-type immune response.Mast cell (MC) is an important immune cell of Th2 immune response and a critical effector cell in IgE-dependent allergic reaction. As an important component of intestinal mucosal barrier, Enterochromaffin cell(EC) is associated with the release n synthesis and reuptake of NE and 5-HT.and participates in mucosal innateimmune reaction.The former two investigations showed that both intestinal mucosal neurotransmitters abnormality and negative affect were the characteristics of IBLS. In this investigation, we count the total number of MC\ EC and 5-HT positive cells and explore the possible pathogenesis and correlation in IBLS.METHODS: Colorectal biopsy specimens were obtained from healthy controls and patients with UC and IBS in west china hospital during march 2004 to august 2004. Mast cells(MC) and enterochromaffin cells(EC) were identified by immunohistochemical methods and investigated qualitatively and quantitatively by means of computed image analysis.RESULTS: (1) The number of mast cells was increased in patients with IBS -, active UC and IBLS, there were significant difference (P<0.05)compared with control and IBS(-)UC groups, there was no significant difference (P>0.05)in the cases between IBS and IBLS, and no significant difference (P>0.05)in the cases between IBS(-)UC and control groups.(2) The number of 5-HT positive cells was increased in patients with TBSy IBLS and Control groups, there were significant difference (PO.05) compared with active UC and JBS(-)UC groups, there were no significant difference (P>0.05)in the cases between IBSn IBLS and control groups.(3) The number of intestinal mucosal enterochromaffin cells was increased in patients with IBS and Control groups, there was significant difference (P<0.05) compared with active UC. there were no significant difference (P>0.05)in the cases between IBS and Control groups.CONCLUSION: (1)EC and 5-HT positive cells may play an important role in the pathogenesis of IBS, and MC may partially participated in themechanism of IBS.(2)the significant increased number of MC and decreased number of EC and 5-HT positive cells are the important characteristics of active UC.(3)There were more similarity of neuroendocrinal cells between IBLS and IBS, which maybe involveed in the pathogenesis of IBLS. (4)Prominent alteration of neuroendocrinal cells could be found in classified groups of UC.which implying different factors in each group.