Detection of Crohnʼs Disease in Patients With Spondyloarthropathies (SpA): A Prospective Capsule Endoscopy-Based Study (SpACE Capsule Study): ACG Category Award

Le résumé fourni par la source

Introduction: Inflammatory bowel disease (IBD) is clinically associated with spondylarthropathies (SpA) in 5-15% of cases. Protocol ileocolonoscopy (IC) assessment demonstrated asymptomatic inflammation characteristic of Crohn's disease (CD) in up to 1/3 of SpA patients. Video capsule endoscopy (VCE) is a superior diagnostic tool to detect small bowel (SB) mucosal pathology. This study compared the accuracy of VCE vs. IC for detection of SB lesions consistent with CD in patients with SpA, and to describe the clinical and laboratory predictors of SB inflammation in this cohort. Methods: Prospective cross-sectional study, of consenting adult patients with SpA. Exclusion criteria included any NSAID use in previous month, or treatment with anti-TNF monoclonal antibodies. Patients were evaluated by VCE (Given/Medtronics) followed by IC with biopsies. SB inflammation was quantified using the Lewis Score (LS); significant inflammation defined as LS ≥350. Screening tests evaluated included fecal calprotectin (FCP); positive levels were ≥ 100 ug/g. NOD2 mutations were assessed using a Sequenom array. A panel of serologic, inflammatory and genetic markers (IBD SGI DiagnosticTM), was performed by Prometheus Labs; results were correlated with the diagnosis of CD. Results: 63 patients (54% F, mean age 42±13 years) were recruited; 2 patients refused IC and were withdrawn. 47% had GI symptoms (chronic diarrhea/abdominal pain/weight loss). Significant bowel inflammation was demonstrated by VCE in 25/61 (41%) vs 8/61 (13.1%) by IC (p=0.036). Positive biopsies were consistent with CD in all cases. Elevated FCP levels significantly correlated with mucosal inflammation on VCE (r2 =0.59, p=0.0001, sensitivity 70.6%, specificity 86.6%). No correlation was observed with GI symptoms or elevated CRP. There was no significant correlation between SGI and VCE (r2 =0.1, p=0.4, sensitivity 26.3%, specificity 82.3%) nor did individual components of SGI correlate with VCE findings. Prevalence of NOD2 mutations was higher in patients with CD (27% vs 11) though not statistically significant (p=0.22). Conclusion: CD involving the SB (Montreal classification L1) is common in SpA. GI symptoms did not predict CD. VCE is superior to IC in detecting CD in patients with known SpA. Of biomarkers evaluated, FCP levels significantly correlated with VCE results.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.