FOOD ALLERGY SENSITIVITY TEST (FAST) WITH ENDOMICROSCOPY OF THE DUODENUM ENABLES TAILORED EXCLUSION DIET IN PATIENTS WITH IRRITABLE BOWEL SYNDROME
Presentation Number: 819View Presentation
AuthorBlock: Ralf Kiesslich2, Hanan Adib-Tezer2, Daniel Teubner2, Thomas Frieling1, Christiane Bayerl2, Nina Katrin Wenda2, Jan Gosepath2
1HELIOS Klinikum Krefeld, Krefeld, Nordrhein-Westfalen, Germany; 2HELIOS Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Hessen, Germany;
Introduction: Patients suffering from irritable bowel syndrome have an increased prevalence of typical and atypical food allergies. Endomicroscopy with food exposition during ongoing upper endoscopy (Food Allergy Sensitivity Test - FAST) is a new diagnostic method for food associates symptoms (Gastroenterology 2019 Jul;157(1):109-118).
Aim of the current clinical observation study was the diagnosis of non-Ig-E dependent atypical food allergies in patients with irritable bowel syndrome.
Methods: IBS patients were identified at two HELIOS centers in Germany based on the Rome III criteria. Francis IBS Severity Score (0-500 points) was evaluated. Ig-E serological testing, celiac serology and skin tests for food allergies were performed. In addition, gastroscopy, colonoscopy, breath tests (lactose intolerance) were performed. Patients without pathological findings received a hypo allergic nutrition for at least three days and underwent in vivo endomicroscopy.
First gastroscopy was performed to exclude any mucosal abnormalities. 5 ml fluorescein (10%) was injected intravenously allowing probe based endomicroscopy (Mauna Kea Technologies, France, Gastro HD probe). Endomicroscopy of the duodenum was performed to verify mucosal integrity (no fluorescein leakage into the lumen). Subsequently different food allergens (wheat flour 3g, dry yeast 1,5g, soy flour 3g, milk powder 1,5g and dry egg white 1,5g) were applied onto the duodenal mucosa and mucosal reaction was endomicroscopically observed two minutes after application of each single allergen. A positive reaction was noted if increased fluorescein leakage and cell shedding was seen within the duodenal lumen (leaky gut - (see figure).
Patients with positive reaction to distinct food allergens were offered a specific elimination diet for six months. Patients without any reaction or a positive reaction before application of food allergens underwent a wheat free diet. Endpoint of the study was the response (>80%) to the diet based on IBS Severity Score after 6 weeks and 6 months.
344 patients with IBS and food related symptoms were screened. 88 were excluded based on pathological findings during pre-test examinations. 256 patient underwent endomicroscopic detection (see table). Patients were subdivided based on the reaction to food exposition.
Conclusions: Endomicroscopy after standardized food exposition onto the duodenal mucosa called FAST is a new diagnostic tool diagnosing atypical food allergies in IBS. Patients with endomicroscopic identified food associated functional changes of the enteric mucosa do profit from an endomicroscopic tailored exclusion diet and show long term improvement of their symptoms.