Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden

Marjorie M Walker; Nicholas J Talley; Linn Inganäs; Lars Engstrand; Michael P Jones; Henry Nyhlin; Lars Agréus; Lars Kjellstrom; Åke Öst; Anna Andreasson

doi:10.1016/j.humpath.2014.10.026

Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden

Hum Pathol. 2015 Feb;46(2):277-83. doi: 10.1016/j.humpath.2014.10.026. Epub 2014 Nov 15.

Authors

Affiliations

¹ Anatomical Pathology, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, 2308 NSW, Australia. Electronic address: [email protected].
² Faculty of Health and Medicine, University of Newcastle, Newcastle, 2308 NSW, Australia.
³ Center of Family Medicine, Karolinska Institutet, SE-141 83 Huddinge Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-141 83 Stockholm, Sweden.
⁴ Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-141 83 Stockholm, Sweden.
⁵ Psychology Department, Macquarie University, North Ryde, 2109 NSW, Australia.
⁶ Internal Medicine, Karolinska Hospital, SE-141 83 Huddinge, Sweden.
⁷ Center of Family Medicine, Karolinska Institutet, SE-141 83 Huddinge Stockholm, Sweden.
⁸ Internal Medicine, Aleris Sabbatsbergs Hospital, SE-113 24 Stockholm, Sweden.
⁹ Pathology, Aleris Medilab, SE-183 53 Täby, Sweden.
¹⁰ Center of Family Medicine, Karolinska Institutet, SE-141 83 Huddinge Stockholm, Sweden; Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden.

PMID: 25540866
DOI: 10.1016/j.humpath.2014.10.026

Abstract

Irritable bowel syndrome (IBS) is a functional disorder defined by symptoms in the absence of overt pathology. Colonic spirochetosis (CS), defined by histologic observation of spirochetal strains of Brachyspira in colonic biopsies, is uncommon and considered of doubtful significance. We aimed to determine the prevalence of CS in the general population, identify subtle colon pathologies, and evaluate a link with symptoms of IBS. Colonoscopy was performed in 745 subjects (aged 19-70 years, mean age 51 years, 43% male) with biopsies (ileum and 4 colonic sites) from a random population sample, Stockholm, Sweden, who completed a validated questionnaire of gastrointestinal symptoms; IBS was identified by Rome III criteria. CS was identified by histology and immunohistochemistry. In a general population, 17 individuals (2.28%; 95% confidence interval, 1.2%-3.5%) were diagnosed as having CS by histology; 6 (35%) had IBS. CS was always present in the sigmoid colon, but only 14 rectal biopsies. Eosinophils were increased in colon biopsies in CS cases versus controls, in the transverse (P = .02), sigmoid colon (P = .001), and rectum (P = .0005) with subepithelial eosinophil clusters (P = .053). Lymphoid follicles (at any site) were present in 13 CS (P = .0003). There was a 3-fold increased risk of IBS in CS (odds ratio, 3.59; 95% confidence interval, 1.27-10.11; P = .015). Polyps and diverticular disease were similar in CS cases and controls. The prevalence of CS in a general population is 2% and associated with nonconstipating IBS. Colonic eosinophilia with lymphoid follicles may signify the presence of CS.

Keywords: Colonic spirochetosis; Eosinophils; Histopathology; Infective colitis; Irritable bowel syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Biopsy
Colon / pathology*
Colonoscopy / methods
Eosinophilia / epidemiology*
Female
Humans
Irritable Bowel Syndrome / diagnosis
Irritable Bowel Syndrome / epidemiology*
Male
Middle Aged
Prevalence
Rectum / pathology*
Sweden / epidemiology
Young Adult