P131 High prevalence of Inflammatory Bowel Disease like findings in endoscopic and pathological samples of patients with common variable immunodeficiency
S. Fernandes*1, C. Moura1, C. Baldaia1, S. Silva2, S. Lopes Silva2, L. Correia1, M. Barbosa2, J. Velosa1
1Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal, 2Centro Hospitalar Lisboa Norte, Imunoalergologia, Lisbon, Portugal
Common variable immunodeficiency (CVID) is an immunological disorder characterized by a primary deficiency in antibody production. Patients are at risk for recurrent infections but paradoxically may present with autoimmune manifestations some resembling inflammatory bowel disease (IBD).
Our aim was to review endoscopic and pathologic findings in patients with CVID and determine the prevalence of IBD like findings.
We reviewed patients with CVID followed in our institution. Reasons for endoscopy included dyspepsia (37.0%) and diarrhea (34.2%) and for colonoscopy diarrhea (55.2%) and suspicion of IBD (20.7%).
Out of 82 patients with CVID, 35 (65.7% males, age 43.2 ± 15.2 years) were reviewed including 86 endoscopies and 50 colonoscopies. Biopsies were taken from the esophagus (8), stomach (52), duodenum (48), ileum (14) and colon (25). Endoscopy was normal in 20.9%. Findings included esophageal candidiasis (5), esophagitis (7), varices (5), gastric polyps (12), ulcers (4) and hyperemia (37), duodenal ulcers (11) and atrophy (10). Pathology revealed chronic gastritis in most patients (48), with Helicobacter pylori being frequent (21.2%). Atrophic gastritis (17), complete intestinal metaplasia (20) and lymphoid aggregates (14) were common findings. 2 patients lacked plasmocytes and 3 resembled lymphocytic gastritis. Gastric carcinoma was diagnosed in 5 patients. CMV inclusions were found in 4 patients. Duodenal specimens showed villous atrophy or irregularity (10), chronic duodenitis (22), cryptitis (7), intraepithelial lymphocytosis (13) and lymphoid aggregates (9). 9 patients lacked plasma cells and 4 patients revealed Giardia infection. Colonoscopy showed ileum (5) and colon ulceration (10), diminished vascular pattern (6) and polyps (8). Ileum showed architectural distortion (16), chronic ileitis (13) and focal cryptitis (5). 2 patients had paucity of plasma cells, 3 granulomas and 2 a collagenous and lymphocytic pattern. Giardia and CMV were detected in 1 patient. Colon samples revealed chronic inflammation (24), reaching the submucosa in 5. Crypt distortion was present in 18 patients with cryptitis in 17. A paucity of plasma and goblet cells were found in 7 and 4 patients respectively. Lymphoid aggregates were frequent (11). 2 patients showed a lymphocytic and 1 a collagenous colitis pattern. Paneth cell metaplasia was found in 5 patients and adenocarcinoma in 2. CMV was detected in 2 patients.
CVID may present with a wide spectrum of both endoscopic and pathologic findings. In our series, up to 30% had findings resembling IBD. This has important implications in both therapy, follow-up and cancer surveillance. We alert to the high incidence of gastrointestinal neoplasia in these patients.