Evidence of intestinal inflammation in patients with cystic fibrosis

Steven L. Werlin, Ishay Benuri-Silbiger, Eitan Kerem, Sam N. Adler, Eran Goldin, Joseph Zimmerman, Netta Malka, Limor Cohen, Shoshana Armoni, Yardena Yatzkan-Israelit, Ari Bergwerk, Micha Aviram, Lea Bentur, Huda Mussaffi, Ingvar Bjarnasson, Michael Wilschanski

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Treatment with pancreatic enzymes fails to completely correct malabsorption and gastrointestinal symptoms in patients with cystic fibrosis (CF). The aim of the present study was to examine the small intestine of patients with CF without overt evidence of gastrointestinal disease using capsule endoscopy (CE). Methods: Patients with CF received the agile patency capsule and, depending on the result of that procedure, then underwent standard CE using the PillCam SB capsule (Given Imaging, Yokneam, Israel). A stool specimen was taken on the same day as the CE for determination of the calprotectin level. Results: Forty-two patients with CF ages 10 to 36 years were included; 29 had pancreatic insufficiency. One patient failed to excrete the patency capsule after 36 hours and was withdrawn from the study. Pulmonary function was mild to moderate with FEV1 68.5% ± 16% predicted. Review of the CE videos showed that most of the patients had varying degrees of diffuse areas of inflammatory findings in the small bowel including edema, erythema, mucosal breaks, and frank ulcerations. There were no adverse events. Fecal calprotectin levels were markedly high in patients with pancreatic insufficiency, 258 μg/g (normal <50). Conclusions: Small bowel mucosal pathology may be detected using CE in most of the patients with CF. The high fecal calprotectin levels found are suggestive of mucosal inflammation, which may correlate with the CE findings. Additional study is required to examine the possible relation of these mucosal lesions, which may be part of a newly identified enteropathy associated with CF, with persistent intestinal malabsorption in many of these patients.

Original languageEnglish
Pages (from-to)304-308
Number of pages5
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume51
Issue number3
DOIs
StatePublished - Sep 2010
Externally publishedYes

Keywords

  • calprotectin
  • capsule endoscopy
  • cystic fibrosis

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