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Confocal Endomicroscopy Intestinal Epithelial Barrier Abnormalities in Individuals Without Documented
Thanh-Hien Trieu1, Sophie Vieujean1, Nicolas Delhougne1
1Department of Gastroenterology, CHU Liège, Liège, Belgium.
Insights
Probe-based confocal endomicroscopy (pCLE) reveals intestinal barrier abnormalities in both inflammatory bowel disease (IBD) patients and non-IBD individuals. These findings highlight the need for further research into the clinical significance of these mucosal changes.
Area of Science:
- Gastroenterology
- Medical Imaging
- Microscopy
Background:
- Inflammatory bowel disease (IBD) patients often exhibit intestinal epithelial barrier anomalies despite achieving remission with therapies like anti-tumor necrosis factor or vedolizumab.
- The presence and nature of these abnormalities in non-IBD individuals and their comparison to IBD patients in remission remain under-investigated.
Purpose of the Study:
- To assess intestinal mucosal abnormalities using probe-based confocal endomicroscopy (pCLE) in non-IBD individuals.
- To compare these findings with IBD patients who are in endoscopic remission.
- To identify factors associated with observed abnormalities.
Main Methods:
- The study included 84 participants: 40 IBD patients on biologic therapy for over 6 months and in endoscopic remission, and 44 non-IBD/non-IBS individuals undergoing screening colonoscopy.
- White light endoscopy and pCLE were performed on the ileum, right colon, transverse colon, left colon, and rectum.
- Demographic, clinical, biological, and morphological data were collected and analyzed.
Main Results:
- pCLE identified abnormalities like fluorescein leakage, blood vessel dilatation, and hypervascularization in both groups across all examined segments.
- Epithelial gaps were noted in the ileum, and crypt dilatation in the colon.
- IBD patients showed slightly more ileal gaps, increased transverse colon fluorescein leakage, and less vessel dilatation compared to non-IBD individuals.
- Abnormalities correlated with hypertension, dyslipidemia, female gender, SSRI use, and family history of IBD or colorectal cancer.
Conclusions:
- Intestinal mucosal abnormalities are detectable via pCLE in both non-IBD individuals and IBD patients in endoscopic remission.
- Further investigation is warranted to elucidate the pathophysiological mechanisms and clinical implications of these findings.
Background And Aims:
Probe-based confocal endomicroscopy (pCLE) allows real-time microscopic visualization of the intestinal mucosa surface layers. Despite remission achieved through anti-tumor necrosis factor or vedolizumab therapy, anomalies in the intestinal epithelial barrier are observed in inflammatory bowel disease (IBD) patients. Our study aimed to assess these abnormalities in non-IBD individuals and compare them with IBD patients in endoscopic remission to identify the associated factors.
Methods:
The study involved 84 patients, 40 with IBD under biologic therapy for over 6 months and in endoscopic remission, and 44 without IBD or irritable bowel syndrome (IBS) undergoing colorectal screening colonoscopy. White light endoscopy and probe-based confocal laser endomicroscopy were performed in the ileum, right colon, transverse colon, left colon, and rectum. Demographic, clinical, biological, and morphological factors were examined.
Results:
pCLE revealed abnormalities in both non-IBD individuals and those with IBD in endoscopic remission, such as fluorescein leakage, blood vessel dilatation, and hypervascularization across all segments, as well as epithelial gaps in the ileum, and crypt dilatation in the colon. Comparing the two groups, IBD patients exhibited slightly more gaps in the ileum, increased fluorescein leakage in the transverse colon, and fewer vessel dilatation in the transverse colon. Abnormalities were more frequent in cases of hypertension (p = 0.03), dyslipidemia (p = 0.02), female gender (p = 0.02), selective serotonin reuptake inhibitor (p = 0.03), and family history of IBD (p = 0.04) or colorectal cancer (p = 0.03).
Conclusion:
Confocal endomicroscopy abnormalities are present in both non-IBD individuals undergoing colorectal cancer screening colonoscopy as in those with IBD in endoscopic remission. Further research is needed to understand the pathophysiological mechanisms of these abnormalities and their clinical impact.
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