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Relative importance of abnormalities of CCK (cholecystokinin) and 5-HT (serotonin) in Giardia-induced post-infectious irritable bowel syndrome and functional dyspepsia.

Aliment Pharmacol Ther. 2010 Feb 2;

Authors: Dizdar V, Spiller R, Singh G, Hanevik K, Gilja OH, El-Salhy M, Hausken T

SUMMARY Background: Post-infectious irritable bowel syndrome (PI-IBS) and functional dyspepsia (FD) has been described after both Campylobacter jejuni gastroenteritis and giardiasis. After C. jejuni there is increased rectal serotonin (5-HT)-containing EC cells and postprandial plasma 5-HT while a pilot study suggested increased plasma cholecystokinin (CCK). Aim: To determine changes in plasma and duodenal mucosal 5-HT and CCK in Giardia-induced PI-IBS. Methods: 32 patients previously infected with Giardia, and 19 who had recovered fully (controls) completed symptom questionnaires. Endoscopic duodenal biopsies were obtained from all subjects and immunohistochemically stained for CCK, 5-HT and CgA containing entero-endocrine cells, and mast cells. 5-HT content was also assessed. 21/32 patients and 19 controls consumed a high-carbohydrate meal while fasting and postprandial plasma CCK and 5-HIAA were measured. Results: PI-IBS patients had increased numbers of CCK cells (p = 0.02) but lower numbers of EC cells (p = 0.009). Plasma CCK did not differ significantly between the groups, but correlated significantly with postprandial dyspepsia scores (r = 0.5, p = 0.05). PI-IBS patients had significantly lower plasma 5-HIAA, before and after meal (p = 0.05) as well as more dyspepsia (p < 0.0001) compared to recovered subjects. Conclusions: Post-infectious bowel dysfunction following Giardia infection is associated with increased duodenal mucosal CCK. Postprandial dyspeptic symptoms correlate better with CCK than measures of 5-HT metabolism.

PMID: 20132151 [PubMed - as supplied by publisher]

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