Colonoscopic evaluation in patients with ankylosing
               spondylitis

To assess the gross intestinal colonoscopic changes and microscopic histopathologic findings of patients with ankylosing spondylitis; to correlate the colonoscopic and histopathologic findings; and to study the relationship of the histopathologic findings with extra-articular manifestations of the disease, HLA-B27, BASFI and BASDAI.

Methods:

This is a cross-sectional study of 22 patients with ankylosing spondylitis. The patients underwent clinical assessment, BASDAI and BASFI application, blood collection for HLA-B27 measurement, and colonoscopy with biopsy of four intestinal segments (terminal ileum, right and sigmoid colons, and rectum).

Results:

Abnormal colonoscopic results were obtained in 13 (59.1%) patients, the major abnormality being intestinal polyps. The groups of normal and abnormal colonoscopic results (n = 9 and n = 13, respectively) were homogeneous regarding age, BASFI, BASDAI, and categorical variables, and the P-value showed no significant difference between groups. The histopathological findings revealed abnormal biopsies in 81%, 90.9%, 90.9% and 86.4% for terminal ileum, right colon, sigmoid colon, and rectum, respectively. The histopathologic results showed no statistically significant association with the extra-articular manifestations, BASFI, BASDAI and HLA-B27 positivity.

Conclusions:

The histological analysis of the four intestinal segments evidenced inflammatory lesions in patients with normal and abnormal colonoscopic results, independently of bowel symptomatology and therapy used in the treatment of the basal disease.

Ankylosing spondylitis; Colonoscopy; Histological analisys; Intestinal alteration; Intestinal inflammatory disease

Variable		n	%
Gender
	Female	3	13.6
	Male	19	86.4
	Race (caucasians)	11	50.0
HLA B27
	Positive	9	40.9
	Undetermined	4	18.2
	Negative	9	40.9
	Presented extra-articular change	6	27.3
	Presented ocular change	5	22.7
	Presented no kidney change	22	100.0
	Presented cardiac change	1	4.5
	Presented no neurological change	22	100.0
	Presented no pulmonary change	22	100.0
Colonoscopy
	Normal	9	40.9
	Abnormal	13	59.1
Sigmoid colon biopsy
	Normal	2	9.1
	Abnormal	20	90.9
	Mild inflammation	17	77.3
	Moderate inflammation	2	9.1
	Severe inflammation	1	4.5
Terminal ileum biopsy
	Normal	4	18.2
	Abnormal	17	81.0
	Mild inflammation	4	18.2
	Moderate inflammation	5	22.7
	Severe inflammation	8	36.4
Right colon biopsy
	Normal	2	9.1
	Abnormal	20	90.9
	Mild inflammation	17	77.3
	Moderate inflammation	2	9.1
	Severe inflammation	1	4.5
Rectal biopsy
	Normal	3	13.6
	Abnormal	19	86.4
	Mild inflammation	14	63.6
	Moderate inflammation	4	18.2
	Severe inflammation	1	4.5

Categorical variable		Colonoscopy, normal (n = 9)		Colonoscopy, abnormal (n = 13)		P-value
		n	%	n	%
Male		8	89%	11	85%	0.774
Caucasians		5	56%	6	46%	0.665
HLA-B27¹1 Sampaio-Barros PD, Azevedo VF, Bonfiglioli R, Campos WR, Carneiro SCS, Carvalho MAP, et al. Consenso Brasileiro de Espondiloartropatias: Espondilite Anquilosante e Artrite Psoriásica Diagnóstico e Tratamento - Primeira Revisão. Rev Bras Reumatol. 2007;47:243-50. negative		5	56%	4	31%	0.489
Absence of:
	Extra-articular change	8	89%	8	62%	0.157
	Ocular change	8	89%	9	69%	0.279
	Cardiac abnormality	9	100%	12	92%	0.394
Abnormal results
	Sigmoid colon biopsy	8	89%	12	92%	0.784
	Terminal ileum biopsy	7	88%	10	77%	0.549
	Right colon biopsy	8	89%	12	92%	0.784
	Rectal biopsy	8	89%	11	85%	0.774

Variable		Sigmoid colon biopsy, normal (n = 2)		Sigmoid colon biopsy, abnormal (n = 20)		P-value^a a Chi-Squared (χ2) test.
Variable		n	%	n	%
Male		2	100%	17	85%	0.556
Caucasians		1	50%	10	50%	1.000
HLA-B27 negative		1	50%	8	40%	0.783
Absence of:
	Extra-articular change	1	50%	15	75%	0.449
	Ocular change	2	100%	15	75%	0.421
	Cardiac abnormality	1	50%	20	100%	0.001
Abnormal results
	Terminal ileum biopsy	1	50%	16	84%	0.241
	Right colon biopsy	0	0%	20	100%	0.000
	Rectal biopsy	0	0%	19	95%	0.000

Variable		Terminal ileum biopsy, normal (n = 4)		Terminal ileum biopsy, abnormal (n = 17)		P-value^a a Chi-Squared (χ2) test.
Variable		n	%	n	%
Male		4	100%	14	82%	0.364
Caucasians		1	25%	9	53%	0.314
HLA-B27 negative		1	25%	7	41%	0.215
Absence of:
	Extra-articular change	3	75%	12	71%	0.861
	Ocular change	3	75%	13	76%	0.950
	Cardiac abnormality	4	100%	16	94%	0.619
Abnormal results
	Terminal ileum biopsy	3	75%	16	94%	0.241
	Right colon biopsy	3	75%	15	88%	0.496
	Rectal biopsy

Variable		Right colon biopsy, normal (n = 2)		Right colon biopsy, abnormal (n = 20)		P-value^a a Chi-Squared (χ2) test.
		n	%	n	%
Male		2	100%	17	85%	0.556
Caucasians		1	50%	10	50%	1.000
HLA-B27 negative		1	50%	8	40%	0.783
Absence of:
	Extra-articular change	1	50%	15	75%	0.449
	Ocular change	2	100%	15	75%	0.421
	Cardiac abnormality	1	50%	20	100%	0.001
Abnormal results
	Rectal biopsy	0	0%	19	95%	0.000

Variable		Rectal biopsy, normal (n = 3)		Rectal biopsy, abnormal (n = 19)		P-value^a a Chi-Squared (χ2) test.
		n	%	n	%
Male		3	100%	16	84%	0.459
Caucasians		1	33%	10	53%	0.534
HLA-B27 negative		1	33%	8	42%	0.537
Absence of:
	Extra-articular change	1	33%	15	79%	0.099
	Ocular change	2	67%	15	79%	0.637
	Cardiac abnormality	2	67%	19	100%	0.010

Sociedade Brasileira de Reumatologia Av Brigadeiro Luiz Antonio, 2466 - Cj 93., 01402-000 São Paulo - SP, Tel./Fax: 55 11 3289 7165 - São Paulo - SP - Brazil
E-mail: sbre@terra.com.br

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[1] * Corresponding author. E-mail: haim.maleh@gmail.com (H.C. Maleh).