title: Small bowel mucosal damage in familial Mediterranean fever: results of capsule endoscopy screening.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Demir
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyüz
authors.forename: Suut
authors.initials: S
authors.lastname: Göktürk
authors.forename: Sami
authors.initials: S
authors.lastname: Evirgen
authors.forename: Umit
authors.initials: U
authors.lastname: Akyüz
authors.forename: Aslı
authors.initials: A
authors.lastname: Örmeci
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Soyer
authors.forename: Cetin
authors.initials: C
authors.lastname: Karaca
authors.forename: Kadir
authors.initials: K
authors.lastname: Demir
authors.forename: Gökcen
authors.initials: G
authors.lastname: Gundogdu
authors.forename: Mine
authors.initials: M
authors.lastname: Güllüoğlu
authors.forename: Burak
authors.initials: B
authors.lastname: Erer
authors.forename: Sevil
authors.initials: S
authors.lastname: Kamalı
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Kaymakoglu
authors.forename: Fatih
authors.initials: F
authors.lastname: Besisik
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gül
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001706:Biopsy; D053704:Capsule Endoscopy; D016022:Case-Control Studies; D003113:Colonoscopy; D010505:Familial Mediterranean Fever / Q000150:complications / Q000473:pathology*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D043183:Irritable Bowel Syndrome / Q000473:pathology; D008297:Male; D008875:Middle Aged
keywords: amyloidosis; capsule endoscopy; colchicine; familial Mediterranean fever; small bowel ulcer