Izquierdo Viviana Parra, Florez Cristian, Molano Wilson Bautista, Beltran Adriana, Jaimes Diego, De Avila Juliette, Casallas Alejandro Ramos, Bello Juan, Gutierrez Jaiber, Philippe Chalem, Romero-Sanchez Consuelo
Hospital Internacional de Colombia, BUCARAMANGA, Colombia.
Gastroenterología y Endoscopia Digestiva, Hospital Internacional de Colombia, Bucaramanga, Colombia. Grupo de Inmunología Celular y Molecular-InmuBo, Universidad del Bosque, Bogota, Colombia.
Am J Gastroenterol. 2021 Dec 1;116(Suppl 1):S16. doi: 10.14309/01.ajg.0000798848.57615.18.
Digital chromoendoscopy (Narrow Band Imaging By Olympus) or BLI (Blue Light Imaging By Fujifilm), with the magnification endoscope, allows a detailed evaluation of the mucosal surface and its vascular network, which facilitates the diagnosis and monitoring of early lesions. This technique has demonstrated a better detection, which allows optical diagnosis during a colonoscopy examination. Patients with SpA with nonspecific gastrointestinal symptoms, subclinical intestinal inflammation are defined as endoscopic and histologically. The aim was to detect early structural inflammatory changes by chromoendoscopy and magnification colonoscopy in colonic/ileum digestive mucosa, and establish its association with clinical variables in SpA and gastrointestinal symptoms. Study approved by Institutional Ethics Committee, code HMC 2017-023.
Clinical evaluation by rheumatologist in SpA patients (ASAS/criteria), fecal calprotectin levels, and HLA-B*27 were evaluated. In patients with ≥2 gastrointestinal symptoms, clinical evaluation by gastroenterologist, digital chromoendoscopy (NBI) or (BLI), magnification colonoscopy, and histological analysis were performed. The association between clinical and colonoscopy variables were established using the Chi-square or Fisher's exact test.
In total, 62 SpA patients were included, with mean age of 45.1 ± 11.3 years, axial SpA (77.4%) peripheral SpA (12.9%), biological treatment (69.4%), ASDAS-CRP>2,1 (67.7%), presence of HLA-B27 (41.9%). Patients with ≥2 gastrointestinal symptoms were found in 67.7%. The most important symptoms were abdominal pain (66.1%), abdominal distension (64.5%), and food intolerance (59.7%). 22.6% of patients showed high level of calprotectin. In those patients with gastrointestinal symptoms, chromoendoscopy and magnification colonoscopy were performed. The mean age of those patients was 45.4 ± 10.5, 57.6% were male, BMI>25 in 69.7%, presence of HLA-B27 in 39.4%, 33.3% were former smokers, axial SpA in 84.8% and ASDAS-CRP>21 in 78.8%. In total, 27.27% of the patients presented high levels of calprotectin, of which 66.0% had more than two gastrointestinal symptoms (p = 0.015). 77.8% presented alterations in ileal mucosa (p=0.060). The most frequent alteration was the loss of vascular pattern (p = 0.002). By histological analysis, 5 patients had acute inflammation in the ileum, of which 4 had increased levels of fecal calprotectin (p = 0.013). 30.8% of patients positive for HLAB*27:05:02 had ulcers in ileum (p = 0.017) and 61.5% had chronic inflammatory patterns (p=0.020).
Chromoendoscopy provided an enhanced, detailed contrast of the gastrointestinal mucosa surface, mainly in the loss of vascular pattern in ileum. The active search for symptoms, signs, and biomarkers of gastrointestinal involvement in addition to an objective endoscopic and histological evaluation may offer new perspectives at the evaluation of SpA patients and may provide guidance for specific clinical and therapeutic management.
数字染色内镜检查（奥林巴斯窄带成像）或蓝光成像（富士胶片蓝光成像）结合放大内镜，可对黏膜表面及其血管网络进行详细评估，有助于早期病变的诊断和监测。该技术已显示出更好的检测效果，可在结肠镜检查期间进行光学诊断。脊柱关节炎（SpA）患者出现非特异性胃肠道症状、亚临床肠道炎症可通过内镜和组织学进行定义。目的是通过染色内镜检查和放大结肠镜检查检测结肠/回肠消化黏膜的早期结构性炎症变化，并确定其与SpA临床变量及胃肠道症状的关联。本研究经机构伦理委员会批准，编号为HMC 2017 - 023。
由风湿病学家对SpA患者进行临床评估（采用ASAS标准），评估粪便钙卫蛋白水平及HLA - B*27情况。对有≥2种胃肠道症状的患者，由胃肠病学家进行临床评估，并进行数字染色内镜检查（窄带成像）或（蓝光成像）、放大结肠镜检查及组织学分析。采用卡方检验或Fisher精确检验确定临床变量与结肠镜检查变量之间的关联。
共纳入62例SpA患者，平均年龄45.1±11.3岁，其中轴向SpA患者占77.4%，外周SpA患者占12.9%，接受生物治疗的患者占69.4%，ASDAS - CRP>2.1的患者占67.7%，存在HLA - B27的患者占41.9%。67.7%的患者有≥2种胃肠道症状。最主要的症状为腹痛（66.1%）、腹胀（64.5%）和食物不耐受（59.7%）。22.6%的患者粪便钙卫蛋白水平升高。对有胃肠道症状的患者进行了染色内镜检查和放大结肠镜检查。这些患者的平均年龄为45.4±10.5岁，男性占57.6%，69.7%的患者BMI>25，39.4%的患者存在HLA - B27，33.3%的患者既往吸烟，84.8%为轴向SpA患者，78.8%的患者ASDAS - CRP>2.1。共有27.27%的患者粪便钙卫蛋白水平升高，其中66.0%的患者有超过两种胃肠道症状（p = 0.015）。77.8%的患者回肠黏膜有改变（p = 0.060）。最常见的改变是血管形态消失（p = 0.002）。通过组织学分析，5例患者回肠有急性炎症，其中4例粪便钙卫蛋白水平升高（p = 0.013）。30.8%的HLA - B*27:05:02阳性患者回肠有溃疡（p = 0.017），61.5%的患者有慢性炎症模式（p = 0.020）。
染色内镜检查能增强并详细显示胃肠道黏膜表面的对比度，主要表现为回肠血管形态消失。除了客观的内镜和组织学评估外，积极寻找胃肠道受累的症状、体征和生物标志物，可能为SpA患者的评估提供新的视角，并可为具体的临床和治疗管理提供指导。
