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Small bowel mucosal damage in familial Mediterranean fever: results of capsule endoscopy screening.
[familial mediterranean fever]
Abstract
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
.
Diseases
Validation
Diseases presenting
"bowel mucosal defects"
symptom
familial mediterranean fever
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