From the divisions of Gastroenterology and Rheumatology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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.
J Rheumatol. 2018 Apr;45(4):498-505. doi: 10.3899/jrheum.161216. Epub 2018 Feb 15.
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.
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).
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.
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.
炎症性肠病（IBD）通常在 5%-15%的病例中与脊柱关节病（SpA）相关。通过协议进行系统的结肠镜评估显示，多达三分之一的 SpA 患者存在特征性的克罗恩病（CD）黏膜炎症。视频胶囊内镜（CE）是一种优于标准结肠镜检查的诊断工具，可用于检测小肠黏膜疾病。本研究比较了 CE 与标准结肠镜检查在 SpA 患者中检测炎症性肠病病变的准确性，并描述了该队列中小肠炎症（SBI）的预测因素。
前瞻性横断面研究随访 SpA 成年患者。患者接受 CE 和标准结肠镜检查及活检。使用 Lewis 评分量化 SBI。额外的筛查测试包括粪便钙卫蛋白（FCP）、C 反应蛋白（CRP）以及一组血清学、炎症和遗传检测（SGI）的诊断性检测。
共招募了 64 名患者（53%为女性，平均年龄 42 ± 13 岁）。57%存在慢性胃肠道（GI）症状。CE 显示 27/64（42.2%）存在明显的 SBI，而标准结肠镜检查显示 7/64（10.9%）（p = 0.035）。FCP 升高与小肠 CD 相关（OR 4.5，95%CI 1.01-19.9；p = 0.042）。与 GI 症状、CRP 或 SGI 结果均无相关性。发现 CD 导致 65.2%的病例改变了治疗方案。
CE 在 42.2%的 SpA 患者中发现了与 CD 一致的 SBI，与结肠镜检查相比有 31%的显著增量收益。FCP 水平与 CE 结果显著相关，而 GI 症状和 SGI 结果对 SBI 的预测作用较差。
