A Cross-Sectional Study of the Prevalence of Gastrointestinal Symptoms and Pathology in Patients With Common Variable Immunodeficiency.

Autor:	Jørgensen SF; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.; K. G. Jebsen Inflammation Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Reims HM; Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Frydenlund D; Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Holm K; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway., Paulsen V; Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway., Michelsen AE; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Jørgensen KK; Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway.; Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway., Osnes LT; Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Bratlie J; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Eide TJ; Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Dahl CP; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Holter E; Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Tronstad RR; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway., Hanevik K; Department of Clinical Science, University of Bergen, Bergen, Norway., Brattbakk HR; Department of Clinical Science, University of Bergen, Bergen, Norway.; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway., Kaveh F; Medical Genetics Department, Oslo University Hospital, Ullevål, Oslo, Norway., Fiskerstrand T; Department of Clinical Science, University of Bergen, Bergen, Norway.; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway., Kran AB; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Microbiology, Oslo University Hospital, Ullevål, Oslo, Norway., Ueland T; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway., Karlsen TH; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; K. G. Jebsen Inflammation Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Aukrust P; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.; K. G. Jebsen Inflammation Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Lundin KE; Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Centre for Immune Regulation, University of Oslo, Oslo, Norway., Fevang B; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2016 Oct; Vol. 111 (10), pp. 1467-1475. Date of Electronic Publication: 2016 Aug 16.
DOI:	10.1038/ajg.2016.329
Abstrakt:	Objectives: The objective of this study was to study the prevalence of gastrointestinal (GI) symptoms and histopathology in patients with common variable immunodeficiency (CVID) as well as linking the findings to GI infections and markers of systemic immune activation. Methods: In this cross-sectional study, we addressed GI symptoms in 103 patients and GI histopathological findings in 53 patients who underwent upper and lower endoscopic examination. The most frequent histopathological findings were linked to GI symptoms, B-cell phenotype, and markers of systemic immune activation (soluble (s)CD14, sCD25, and sCD163). Microarray analysis compared "celiac-like disease" in CVID to celiac disease. Screening for selected bacterial and viral infections in fecal samples and gut mucosal biopsies was performed. Results: The main findings of this study were as follows: most common GI symptoms were bloating (34%), pain (30%), and diarrhea (26%). The most frequent histopathological findings were increased intraepithelial lymphocytes in the descending part of the duodenum, i.e., "celiac-like disease" (46% of patients), decreased numbers of plasma cells in GI tract mucosa (62%), and lymphoid hyperplasia (38%), none of which were associated with GI symptoms. Reduced plasma cells in GI mucosa were associated with B-cell phenotypic characteristics of CVID, and increased serum levels of sCD14 (P=0.025), sCD25 (P=0.01), and sCD163 (P=0.04). Microarray analyses distinguished between CVID patients with "celiac-like disease" and celiac disease. Positive tests for bacterial and viral infections were scarce both in fecal samples and gut mucosal biopsies, including PCR test for norovirus in biopsy specimens (0 positive tests). Conclusions: In conclusion, GI pathology is common in CVID, but does not necessarily cause symptoms. However, reduced plasma cells in GI mucosa were linked to systemic immune activation, "celiac-like disease" in CVID and true celiac disease appear to be different disease entities, as assessed by gene expression, and infections (including norovirus) are rarely a cause of the CVID enteropathy.
Databáze:	MEDLINE
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