The findings of capsule endoscopy in patients with common variable immunodeficiency syndrome

Common variable immunodeficiency syndrome (CVIS) is a primary immunodeficiency disorder characterized by reduced serum immunoglobulins and heterogeneous clinical features. Parasitic and bacterial infections are very common complications of the syndrome. Capsule endoscopy (CE) represents a new and highly innovative method of demonstrating the small intestinal diseases. We evaluated the practical usefulness and diagnostic yield of CE in three patients with CVIS.

Between January 2003 and September 2004 CE was performed in 31 patients for different indications including mostly obscure gastrointestinal bleeding. We particularly evaluated 3 patients with CVIS whose diagnosis was based on serum immunoglobulins levels, clinical features and intestinal biopsy. The three CVIS patients with a median age of 25.6 years (ranged 21-34 years) have been followed-up for a period of 6.3 years (range 3-9 years). After introduction of CE in our medical center, this technique was performed with a Given M2A video capsule system in three patients to explain chronic severe and refractory diarrhea and iron deficiency anemia.

All three patients were able to complete the study. In one of the three patients, CE demonstrated unlimited sessile and sometimes pedunculated polyp-like lesions of 2 to 6mm in diameter starting from antrum of the stomach to terminal ileum without escaping fashion and a parasite, Hymenolepsis nana that was located in the ileum of the patient. Biopsy obtained by conventional endoscopy from small intestine and antrum demonstrated typical nodular lymphoid hyperplasia. In the second patient, the same capsule endoscopic and histological findings were found on the mucosa of the duodenum and jejunum but not ileum and the stomach. In the third patient in whom the follow-up period was 3 years, CE revealed no abnormality through the small intestine.

Our data indicated that CE may be necessary for the patients with CVIS to evaluate not only the complications but also extension of the small intestinal involvement.