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Confocal endomicroscopy confirms barrier dysfunction in duodenum of IBD patients
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Confocal laser endomicroscopy demonstrated for the first time that epithelial damage and barrier loss is not confined to the terminal ileum in patients with inflammatory bowel disease, but also is present in the duodenum, according to study results.
In a prospective study, researchers recruited patients from a university hospital endoscopy unit with Crohn’s disease (CD; n=15) and ulcerative colitis (UC; n=10), along with controls without colonic disease (n=10). Patients underwent fluorescein-aided esophagogastroduodenoscopy with a confocal laser endomicroscope (CLE), which was performed on macroscopically normal antral and duodenal (D1, D2, D3, D4) mucosa.
Images were analyzed and scored for epithelial gaps, cell shedding, and fluorescein leakage into the intestinal lumen. Scores were simplified using the Watson grading scale and categorized as normal, functional defect or structural defect.
Both CD and UC patients had significantly greater epithelial gap scores, more cell shedding and more leakage of fluorescein in the duodenum compared with controls. Watson scores indicated the same statistical trends when comparing CD patients (D1-D3: P<.001; D4: P=.006) and UC patients (D1-D3: P<.001; D4: P=.012) with controls. Watson scores were numerically but not significantly greater in patients with CD compared with UC patients. In comparing patients with active vs. inactive CD, increases were observed only in D2 (P=.04) and D3 (P=.257) cell shedding among active CD patients.
Data indicated that “both UC and CD patients have a structural epithelial defect in terms of increased shedding and gap formation when compared with healthy patients.” The researchers also wrote that the duodenal mucosa appeared normal in conventional endoscopy, while CLE enabled identification of local barrier dysfunction when present.
“These findings have important implications for disease pathogenesis and suggest that CLE of the duodenum may be of diagnostic value in [inflammatory bowel disease], providing a basis for further study in this area,” the investigators concluded.
Disclosure: Kiesslich reports receiving an unrestricted grant from Pentax Europe and free instruments via Optiscan.
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