3rd Annual BMRP Investigator Meeting - Abstract
Wireless Capsule Endoscopy and Intestinal Permeability in Asymptomatic First-Degree Relatives of Crohn’s Patients
Joseph Romagnuolo1,2,a, Robert Hilsden2, Jon Meddings3, Remo Panaccione2, Mark Silverberg4 and Paul Beck2
1,2Department of Medicine, Division of Gastroenterology, Medical University of South Carolina (Charleston, South Carolina, U.S.A.); 2University of Calgary (Calgary, Canada); 3University of Alberta (Edmonton, Canada); 4University of Toronto (Toronto, Canada).
Background: Intestinal permeability (lactose-mannitol (L/M) absorption) is increased in asymptomatic relatives of Crohn’s disease (CD) patients, active CD, and other erosive intestinal disease (e.g., NSAID use). Whether this is a primary phenomenon, predisposing one to CD or simply a marker of subclinical CD is unknown. Wireless capsule endoscopy (WCE) is more sensitive than traditional radiological small bowel imaging.
Aim: To estimate the prevalence of WCE abnormalities in first-degree relatives of patients with CD stratified by L/M results.
Methods: Asymptomatic first-degree relatives of CD patients were invited to participate and informed consent was obtained. Consent to release relevant medical records was obtained from affected relatives. A screening history and physical confirmed asymptomatic status and lack of confounding factors (recent gastroenteritis, active NSAID use). Routine blood work was obtained and samples were banked for genetic testing. L/M testing was performed. WCE was performed after a small bowel follow through (SBFT) confirmed absence of obstruction and obvious mucosal disease. WCEs were double-read using a five-point Likert scale from definitely normal to definitely abnormal, while blinded to L/M results. Abnormalities were described (focal erythema, single erosions > 2cm apart, multiple erosions<2cm apart, and ulcerations). Optional endoscopy is offered to subjects with abnormal WCE. Annual follow-up is planned. Analysis includes 95% binomial confidence intervals (CI) for proportions of patients with likely and/or definite CD on WCE, stratified by L/M results. 40 subjects per group is the target sample size.
Results: To date, after screening of potential subjects, ten subjects have qualified and have undergone L/M testing, SBFT, and WCE successfully. Blood work was performed and serum banked; planned batched genetic testing has not yet been performed. Three (30% (95%CI: 7-65%); p<0.05 vs. zero expected) WCE exams were rated as likely or definitely abnormal, one (10%) as indeterminate, and six (60%) as likely or definitely normal. Abnormalities ranged from suspected erosions to suspected ileal ulcers. Confirmatory conventional endoscopy and biopsy has not yet been done.
Conclusions: WCE mucosal abnormalities are relatively common in this asymptomatic cohort of first-degree relatives of CD and may represent an explanation for abnormal intestinal permeability in this group.
aPrincipal Investigator