Evidence of intestinal inflammation in patients with cystic fibrosis.
OBJECTIVE
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 One patient failed to excrete the patency capsule after 36 hours and was withdrawn from the study.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 microg/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.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Steven L
SL
Werlin
Ishay
I
Benuri-Silbiger
Eitan
E
Kerem
Sam N
SN
Adler
Eran
E
Goldin
Joseph
J
Zimmerman
Netta
N
Malka
Limor
L
Cohen
Shoshana
S
Armoni
Yardena
Y
Yatzkan-Israelit
Ari
A
Bergwerk
Micha
M
Aviram
Lea
L
Bentur
Huda
H
Mussaffi
Ingvar
I
Bjarnasson
Michael
M
Wilschanski
D000293:Adolescent; D000328:Adult; D053704:Capsule Endoscopy / Q000379:methods; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D004487:Edema / Q000209:etiology; D004890:Erythema / Q000209:etiology; D010188:Exocrine Pancreatic Insufficiency / Q000453:epidemiology* / Q000209:etiology; D005243:Feces / Q000737:chemistry; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000209:etiology / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology / Q000473:pathology*; D014456:Ulcer / Q000209:etiology; D055815:Young Adult
D039841:Leukocyte L1 Antigen Complex