Gut Inflammation in Chronic Fatigue Syndrome

Shaheen E Lakhan; Annette Kirchgessner

Disclosures

Nutr Metab. 2010;7(1) 

In This Article

Mucosal Barrier Function

To protect itself from uncontrolled inflammatory responses, the intestinal epithelium has developed mechanisms to restrain bacterial growth, limit direct contact with the bacteria, and prevent bacterial dissemination into underlying tissue. The mucosal barrier, which consists of only a single layer of epithelial cells, is one of the most important components of the innate immune system, and all that separates the inside of the body from a very "dirty" outside environment. Thus, mucosal barrier function is a key component in the arsenal of defense mechanisms required to prevent infection and inflammation. Mucosal barrier function is maintained by several interrelated systems, including mucous secretion, chloride and water secretion, and binding together of epithelial cells at their apical junctions by tight junction proteins. Together, they act as the "gatekeeper" of the mucosal barrier.

Disruption of mucosal barrier function occurs in CFS as demonstrated by the increased serum concentrations of IgA and IgM to LPS of gram-negative enterobacteria.[12] Psychological stress disrupts the mucosal barrier allowing increased entry of antigens and microorganisms, which in turn is expected to stimulate hyperactive responses in the mucosal immune system. For example, chronic water avoidance stress in rats induces increases in the adherence of bacteria to intestinal epithelial cells, bacterial internalization into enterocytes and the appearance of bacteria in the lamina propria.[48] Consequently, mucosal barrier dysfunction causes alterations in gut motility, abnormal secretion, and changes in visceral sensation that could contribute to symptom generation. This may at least partially explain the link between stress and CFS. The relationship between IBS and CFS may also reflect in part disorders in gut permeability as altered gut microbiota (e.g., higher numbers of Veillonella and Lactobacillus than healthy controls) and a disrupted mucosal barrier are found in patients with IBS.[49,50] Furthermore, IBS patients with high acetic acid or propionic acid levels presented more severe symptoms, impaired quality of life and negative emotions.[50]

Butt and colleagues reported that fatigue presentation in CFS patients with symptoms of IBS was more severe than in CFS patients without irritable bowel.[46] Furthermore, patients with both CFS and IBS had poorer appetite, increased abdominal pain, increased severity of loose stools, diarrhea, nausea, and gastric reflux. The gut microbiota influences the sensory, motor and immune system of the gut and interacts with higher brain centers even at extremely low levels.[50] So aberrant gut microbiota and gut barrier dysfunction may actually be creating an "irritable" bowel. Altered intestinal microbiota and gut barrier dysfunction could also contribute to the symptoms of CFS through increased translocation of LPS from gram-negative enterobacteria.

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