Uri Kopylov1,2, Michael Starr1,2, Craig Watts1,2, Serge Dionne1,2, Marc Girardin1,2, Ernest G Seidman3,4. 1. From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 2. U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University. 3. From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Ernest.Seidman@McGill.ca. 4. U. Kopylov, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Starr, MD, Division of Rheumatology, Faculty of Medicine, McGill University; C. Watts, MD, Division of Rheumatology, Faculty of Medicine, McGill University; S. Dionne, PhD, Division of Gastroenterology, Faculty of Medicine, McGill University; M. Girardin, MD, Division of Gastroenterology, Faculty of Medicine, McGill University; E.G. Seidman, MDCM, FRCPC, FACG, Division of Gastroenterology, Faculty of Medicine, McGill University. Ernest.Seidman@McGill.ca.
Abstract
OBJECTIVE: Inflammatory bowel disease (IBD) is generally reported to be associated with spondylarthropathies (SpA) in 5%-15% of cases. Systematic colonoscopic assessment by protocol demonstrated mucosal inflammation characteristic of Crohn disease (CD) in up to one-third of patients with SpA. Video capsule endoscopy (CE) is a superior diagnostic tool to detect small bowel mucosal disease. Our study compared the accuracy of CE to standard colonoscopy for detection of inflammatory bowel lesions in patients with SpA, and to describe predictors of small bowel inflammation (SBI) in this cohort. METHODS: Prospective cross-sectional study of adult patients followed for SpA. Patients were evaluated by CE and standard colonoscopy with biopsies. SBI was quantified using the Lewis Score. Additional screening tests included fecal calprotectin (FCP), C-reactive protein (CRP), and a diagnostic panel of serologic, inflammatory and genetic tests (SGI). RESULTS: There were 64 patients recruited (53% female, mean age 42 ± 13 yrs). Chronic gastrointestinal (GI) symptoms were present in 57%. CE revealed significant SBI in 27/64 (42.2%), compared to 7/64 (10.9%) by standard colonoscopy (p = 0.035). Elevated FCP was associated with small bowel CD (OR 4.5, 95% CI 1.01-19.9; p = 0.042). No correlation was observed with presence of GI symptoms, CRP, or SGI results. Finding CD led to a change in management in 65.2% of cases. CONCLUSION: CE uncovered SBI consistent with CD in 42.2% of patients with SpA, with a significant incremental yield over colonoscopy of 31%. FCP levels were significantly correlated with CE results, while GI symptoms and SGI results were poor predictors of SBI.
OBJECTIVE:Inflammatory bowel disease (IBD) is generally reported to be associated with spondylarthropathies (SpA) in 5%-15% of cases. Systematic colonoscopic assessment by protocol demonstrated mucosal inflammation characteristic of Crohn disease (CD) in up to one-third of patients with SpA. Video capsule endoscopy (CE) is a superior diagnostic tool to detect small bowel mucosal disease. Our study compared the accuracy of CE to standard colonoscopy for detection of inflammatory bowel lesions in patients with SpA, and to describe predictors of small bowel inflammation (SBI) in this cohort. METHODS: Prospective cross-sectional study of adult patients followed for SpA. Patients were evaluated by CE and standard colonoscopy with biopsies. SBI was quantified using the Lewis Score. Additional screening tests included fecal calprotectin (FCP), C-reactive protein (CRP), and a diagnostic panel of serologic, inflammatory and genetic tests (SGI). RESULTS: There were 64 patients recruited (53% female, mean age 42 ± 13 yrs). Chronic gastrointestinal (GI) symptoms were present in 57%. CE revealed significant SBI in 27/64 (42.2%), compared to 7/64 (10.9%) by standard colonoscopy (p = 0.035). Elevated FCP was associated with small bowel CD (OR 4.5, 95% CI 1.01-19.9; p = 0.042). No correlation was observed with presence of GI symptoms, CRP, or SGI results. Finding CD led to a change in management in 65.2% of cases. CONCLUSION: CE uncovered SBI consistent with CD in 42.2% of patients with SpA, with a significant incremental yield over colonoscopy of 31%. FCP levels were significantly correlated with CE results, while GI symptoms and SGI results were poor predictors of SBI.
Entities:
Keywords:
ANKYLOSING SPONDYLITIS; BIOMARKERS; CROHN DISEASE; SPONDYLOARTHRITIS; VIDEO CAPSULE ENDOSCOPY
Authors: Jonas Sagard; Tor Olofsson; Elisabeth Mogard; Jan Marsal; Kristofer Andréasson; Mats Geijer; Lars Erik Kristensen; Elisabet Lindqvist; Johan K Wallman Journal: Arthritis Res Ther Date: 2022-02-12 Impact factor: 5.156