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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
"edema"
symptom
acute rheumatic fever
adrenomyeloneuropathy
aniridia
cadasil
canavan disease
classical phenylketonuria
coats disease
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
erythropoietic protoporphyria
esophageal carcinoma
fabry disease
familial mediterranean fever
focal myositis
harlequin ichthyosis
homocystinuria without methylmalonic aciduria
inclusion body myositis
lamellar ichthyosis
liposarcoma
lymphangioleiomyomatosis
malignant atrophic papulosis
pleomorphic liposarcoma
systemic capillary leak syndrome
trochlear dysplasia
von hippel-lindau disease
waldenström macroglobulinemia
This symptom has already been validated
