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Epithelial gap density associated with increased risk for major IBD clinical events
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Patients with IBD may be at increased risk for hospitalization or surgery with the presence of elevated epithelial gap density in the small intestine, according to recent results.
In a prospective, double blind study, researchers evaluated 21 patients with Crohn’s disease (CD) and 20 with ulcerative colitis (UC) for a median follow-up of 14 months after colonoscopy using probe-based confocal laser endomicroscopy (pCLE). The purpose of the study was to determine the potential relationship between epithelial gaps in the small intestine detected during the procedure and complications from IBD, including hospitalization, surgery and flares, among other factors.
Major events were experienced by seven patients, including three who received surveillance colonoscopy and four who underwent screening for symptomatic evaluation. Patients whose pCLE screenings revealed increased gap density were at increased risk for both surgery and hospitalization related to IBD during follow-up (P=.02). An HR of 1.10 (95% CI, 1.01-1.20) for major IBD-related events was calculated for every 1% increase in gap density, which was significantly more common among male patients than females (median 9.0 vs. 3.6 gaps per 100 cells, P=.038). Whether disease was active or inactive did not impact the risk of hospitalization or surgery.
IBD flares were experienced by 10 patients, and investigators observed a marginal correlation between epithelial gap density and the number of flares during follow-up (P=.08). A correlation between duration of IBD and increased gap density was also established (P=.004). No association was found between gap density and C-reactive protein levels or endoscopic disease severity or location.
“Consistent with a recent report that barrier dysfunction from cell extrusion is predictive of disease relapse, our results indicate that gap density, a semi-quantitative measure of cell extrusion, is a linear predictor for future major events such as hospitalization or surgery in IBD,” the researchers wrote. “CLE evaluation of the terminal ileum during colonoscopy may enable clinicians to further risk stratify IBD patients.”
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