Review: Food‐induced mucosal alterations visualized using endomicroscopy

作者：Lukas Michaja Balsiger, Monica Rusticeanu, Jost Langhorst, Christian Sina, Robert Benamouzig, Clifton Huang, Jan Tack, Ralf Kießlich · 发表于：Neurogastroenterology & Motility · 年份：2024 · DOI：10.1111/nmo.14930 · 被引用次数：10 · 研究领域：Gastrointestinal motility and disorders、Eosinophilic Esophagitis、Microscopic Colitis

Confocal laser endomicroscopy (CLE) is a novel technique allowing real time in vivo microscopy during standard endoscopy. Recently, acute mucosal alterations after food administration visualized by CLE have been linked to symptoms in irritable bowel syndrome (IBS). Interestingly, the observed reactions occurred in subjects without demonstrable allergic sensitization to food-this is in line with mechanistic research showing local but not systemic allergic sensitization to foods in an animal model for IBS. Here, European experts conducting CLE with food administration provide a narrative review of the available literature and propose practical guidance on the use of this technique. CLE allows physicians to observe acute mucosal reactions after the application of food to the duodenal mucosa in patients with functional gastrointestinal disorders. Some open-label interventions show a symptomatic benefit when patients exclude the nutrient that triggered an acute mucosal reaction. However, many technical, mechanistic, and clinical questions remain unanswered to date. Technically, the interobserver variability and learning curve requires systematic evaluation and criteria or cutoffs for alterations require validation. Mechanistic studies are needed to enhance our understanding of the mechanisms underlying observed alterations. Finally, rigorous blinded controlled studies are needed to assess a link of these observed alterations with symptom generation. CLE offers a platform allowing ...