Detection of Small Bowel Inflammation Characteristic of Crohnʼs Disease in Spondyloarthropathy by Capsule Endoscopy Compared to Ileocolonoscopy: Preliminary Results of the Space Study

Abstract

Purpose: Spondyloarthropathies (SpA) are associated with clinical IBD in 10-15% of cases. A higher percentage of SpA patients have subclinical gut inflammation, documented by endoscopic, serologic, or histologic findings. HLA B27 seems to be less present in SpA-IBD association than in idiopathic SpA, but there is evidence for the association between gut inflammation in SpA and Crohn's disease (CD) related CARD 15 mutations. Capsule endoscopy (CE) has a higher detection rate for small bowel (SB) inflammation, compared to ileo-colonoscopy (IC) and imaging modalities. The aim is to determine the prevalence of IBD in SpA patients, comparing CE and IC. Methods: To date 15 (10 M) of 80 projected SpA patients (all HLA B27+), with (n=12) or without (n=3) digestive symptoms underwent SB CE, followed by IC and biomarkers (CRP, Hgb). Their age range was 22-63 years. CE was scored by the Lewis index (Gralnek, et al. Aliment Pharmacol Ther 2008). IC was performed blinded to CE results. Results: CE revealed findings consistent with active SB CD in 8 cases (53.3%). IC was positive in 50% of the CD cases to date, and in none of the 7 cases with normal CE. The sensitivity, specificity, positive and negative predictive values of the CRP were: 57%, 71.4%, 66.7%, and 62.5%. Values for Hgb were: 14.3%, 84.6%, 33.3% and 71.4%, respectively. Conclusion: These preliminary results show that CE of the SB is superior to IC in detecting CD in patients with known SpA. Neither the CRP nor Hgb appear to be reliable screening tests for the co-existence of these inflammatory disorders. Serological and genetic marker analyses are pending, in order to determine their predictive value in a larger cohort in this ongoing study. Disclosure: Dr Seidman is a consultant and a member of the speakers' bureau for Given Imaging Inc and for Abbott Laboratories (Canada). Abbott Laboratories provided financial support for this study. Given Imaging provided support in kind (capsules).