Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Division of Gastroenterology and Hepatology, Division of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Gastroenterol Hepatol. 2023 Dec;38(12):2083-2089. doi: 10.1111/jgh.16342. Epub 2023 Sep 24.
Patients with chronic granulomatous disease (CGD) may develop inflammatory bowel disease (IBD). Characterization of small bowel disease in this cohort is scarce. Here, we sought to determine the prevalence and characteristics of small bowel disease and evaluate the clinical utility of video capsule endoscopy (VCE) for its diagnosis.
A retrospective study was performed on patients with CGD who were evaluated for gastrointestinal disease with VCE as a part of ongoing natural history studies at a single academic center. VCEs were reviewed for inflammatory findings and severity of disease utilizing the Capsule Endoscopy Crohn's Disease Activity Index. Radiographic studies and endoscopies performed within 30 days of VCE were compared with small bowel inflammatory findings.
Twenty-six VCEs corresponding to 25 patients were found. The majority of patients were male and White; mean age was 28 years old. The majority (85%) demonstrated presence of small bowel inflammatory findings on VCE including strictures, ulcers, erosions, and erythema. Duodenal and ileal inflammatory disease on endoscopy did not correlate with disease on VCE. Moderate-severe colonic disease correlated with moderate-severe disease on VCE. Radiography did not correlate with disease on VCE. Prolonged small bowel transit time correlated with moderate-severe small bowel disease.
Small bowel IBD was highly prevalent in this cohort of patients with CGD. Limitations included small sample size. Given that radiology and duodenal/ileal disease did not correlate with VCE findings, VCE-driven investigation of small bowel disease should be considered in patients with CGD-associated IBD, particularly those with colonic disease.
慢性肉芽肿病（CGD）患者可能会发生炎症性肠病（IBD）。该队列中小肠疾病的特征描述较少。在此，我们旨在确定小肠疾病的患病率和特征，并评估视频胶囊内镜（VCE）在其诊断中的临床应用价值。
对在一家学术中心进行的胃肠道疾病评估中接受 VCE 检查的 CGD 患者进行了一项回顾性研究。利用胶囊内镜克罗恩病活动指数（Capsule Endoscopy Crohn's Disease Activity Index）对 VCE 检查的炎症发现和疾病严重程度进行评估。比较了 VCE 检查后 30 天内进行的放射影像学检查和内镜检查与小肠炎症发现的相关性。
共发现 26 次 VCE 检查，对应 25 例患者。大多数患者为男性和白人；平均年龄为 28 岁。大多数（85%）患者的 VCE 检查结果显示存在小肠炎症表现，包括狭窄、溃疡、糜烂和红斑。内镜检查的十二指肠和回肠炎症性疾病与 VCE 上的疾病无相关性。中重度结肠疾病与 VCE 上的中重度疾病相关。影像学检查与 VCE 上的疾病无相关性。小肠转运时间延长与中重度小肠疾病相关。
该 CGD 患者队列中 IBD 患者的小肠 IBD 患病率较高。本研究的局限性在于样本量小。鉴于放射影像学和十二指肠/回肠疾病与 VCE 检查结果不相关，对于 CGD 相关 IBD 患者，尤其是伴有结肠疾病的患者，应考虑基于 VCE 发现对小肠疾病进行检查。
