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Small bowel mucosal damage in familial Mediterranean fever: results of capsule endoscopy screening
Abdurrahman Demir1, Filiz Akyüz, Suut Göktürk
1Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey.
Objective:
Familial Mediterranean fever (FMF) is the most common form of autoinflammatory diseases. We aimed to evaluate the small bowel mucosa by capsule endoscopy (CE) in FMF patients for investigation of other possible causes of abdominal pain.
Material And Methods:
The study group consisted of 41 patients with FMF. A standard questionnaire was used to record the gastrointestinal symptoms, other clinical findings, Mediterranean fever gene (MEFV) mutations, and history of medications including non-steroidal anti-inflammatory drugs (NSAIDs). Gastroscopy, colonoscopy and small bowel CE were performed in all patients, and biopsies were taken from terminal ileum and duodenum.
Results:
The mean age of the patients was 34 ± 11 years, 63% of them were female, and 76.5% of them were carrying MEFV exon 10 mutations. Only one patient used NSAIDs in addition to colchicine. In endoscopic investigations, gastric erosion was detected in only one patient, and no significant findings were detected in colonoscopy. CE showed small bowel mucosal defects in 44% (erosions in 26.8%, ulcer in 17.1%) and edema in 29.3% of the patients. Most (64%) of the ulcer and erosions were localized to jejunum, and only 24% were in ileum. Mitotic changes as an indirect finding of colchicine toxicity were not different from the changes observed in samples of independent group of patients with irritable bowel syndrome.
Conclusion:
Mucosal defect was observed in half of the FMF patients, which may be associated with underlying inflammation or chronic colchicine exposure. Detection of nonspecific chronic inflammation without mitotic changes supports that mucosal defects may be associated with the autoinflammatory process.
Insights
Capsule endoscopy revealed small bowel mucosal defects in nearly half of Familial Mediterranean Fever (FMF) patients, potentially linked to autoinflammation or colchicine treatment.
Area of Science:
- Gastroenterology
- Internal Medicine
- Genetics
Background:
- Familial Mediterranean Fever (FMF) is a prevalent autoinflammatory disorder.
- Abdominal pain is a common symptom in FMF patients, with varied potential etiologies.
- Evaluating small bowel involvement is crucial for comprehensive FMF management.
Purpose of the Study:
- To assess the small bowel mucosa using capsule endoscopy (CE) in FMF patients.
- To investigate potential causes of abdominal pain beyond known FMF manifestations.
- To correlate endoscopic findings with MEFV mutations and treatment history.
Main Methods:
- 41 FMF patients underwent gastroscopy, colonoscopy, and small bowel CE.
- Standard questionnaires collected data on gastrointestinal symptoms, clinical findings, MEFV mutations, and medication use (including NSAIDs).
- Biopsies were obtained from the terminal ileum and duodenum.
Main Results:
- CE identified small bowel mucosal defects in 44% of patients (erosions 26.8%, ulcers 17.1%) and edema in 29.3%.
- Lesions were predominantly in the jejunum (64%) rather than the ileum (24%).
- No significant gastric or colonic findings were noted; colchicine toxicity markers were not elevated.
Conclusions:
- Nearly half of FMF patients exhibit small bowel mucosal defects.
- These defects may stem from the underlying autoinflammatory process or chronic colchicine exposure.
- Findings suggest nonspecific chronic inflammation, supporting a link between mucosal abnormalities and the autoinflammatory nature of FMF.
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