Confocal Laser Endomicroscopy Findings of the Small Intestine in Irritable Bowel Syndrome (IBS)
Bibliographic record
Abstract
Purpose: Increased epithelial cell extrusion may result in barrier dysfunction. Increased intestinal permeability has been reported in irritable bowel syndrome (IBS) patients. Confocal laser endomicroscopy (CLE) can accurately identify epithelial gaps left in the lining of the intestine where epithelial cells are extruded. There are no reports of characteristic endoscopic findings which defines IBS. The aim of this study was to examine and quantify epithelial gaps and cells of the terminal ileum using probe-based CLE (pCLE) in IBS patients and healthy controls during routine colonoscopy. Methods: This was a prospective, controlled cohort study of IBS patients and healthy controls undergoing fluorescein-aided pCLE of the terminal ileum during standard of care colonoscopy at the University of Alberta Hopsital. IBS was defined by clinical symptoms based on the Rome III criteria. pCLE images were reviewed and quantitated for epithelial cells and gaps by two independent blinded reviewers. All IBS patients had random biopsies of the terminal ileum and colon to rule out other pathologies. Results: Thirty-five patients (18 controls and 17 IBS) with a mean age of 45.6±14.6 years were recruited. The baseline demographics of the two groups were similar. One IBS patient was excluded from analysis due to evidence of microscopic colitis on biopsy. Of the 16 remaining IBS patients, 12 had diarrhea- and 4 constipation-predominant IBS. For gap density determination, a mean of 4.5±0.4 villi were manually counted, with 190±19 cells and 12.8±2.1 epithelial gaps per patient. The median epithelial gap densities for control and IBS patients were 0.6 and 3.2 gaps per 100 cells, respectively (p<0.001). Using 3% (the estimated 90th percentile of the control population) as cut off for an abnormal value, the diagnostic accuracy of gap density in IBS patients were as followed: sensitivity of 62%, specificity of 89%, positive predictive value of 83%, and negative predictive value of 73%. Conclusion: The density of epithelial gaps as determined by pCLE during colonoscopy was significantly higher in IBS patients and may have potential as a diagnostic test. The clinical significance of the pCLE findings warrants further investigation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".