J CHANG,1,2 M IP,2 M YANG,2 B WONG,2 M ARSHI,3 T PHAN,3 R LEONG1,2 1Gastroenterology and Liver Services, Bankstown Hospital, South Western Sydney Local Health District, 2The University of New South Wales, 3Garvan Institute of Medical Research, Sydney Background: It
is increasing recognized that patients with inflammatory bowel disease (IBD) with mucosal healing (MH) who continue to have ongoing symptoms, may be suffering from possible irritable bowel syndrome (IBS) overlap. Impairments in small intestinal permeability have previously been demonstrated by confocal laser endomicroscopy (CLE) in patients with IBD and IBS cohorts independently, but little is known in those suffering with both. Aims: This study aims to examine small intestinal permeability using CLE (EC-3870FK, Pentax) in symptomatic selleck screening library and asymptomatic IBD patients who have complete mucosal healing. Methods: Patients with IBD were prospectively recruited from Bankstown-Lidcombe Hospital for CLE. Confocal images were obtained with fluorescein sodium as an intravenous contrast from 5 separate sites within the terminal ileum. Only patients with MH were included for final analysis. This was defined in Crohn’s Disease (CD) as no endoscopic disease and in Ulcerative colitis (UC) as endoscopic Mayo score of 0 or 1. All patients had histology to demonstrate no active disease. Blinded
post procedure interpretation of images were performed with previously validated CLE features of “fluorescein leak”, “cell junction enhancement” and “cell drop out”. Calculation of a numerical “confocal leak score” (CLS), allowed quantification Selumetinib of the degree of small intestinal permeability. Patients were assessed to be symptomatic in CD based on their Crohn’s Disease Activity Index >150 and in UC with a partial mayo medchemexpress >2. A symptom diary of diarrhoea motions/day and severity of abdominal pain was
collected. 20 healthy controls also underwent CLE for assessment of normal range. Statistical analysis was performed using the Mann Whitney U for non-parametric data, chi square for categorical outcomes, spearman rank for correlation and regression analysis to establish the association of symptoms to CLS. Results: A total of 71 consecutive CLE cases (exclusive of 20 controls) were performed with 41 cases fulfilling the condition of MH, (61% F, 22 CD, 19 UC). 33 cases were classified into asymptomatic and 8 symptomatic based on the above criteria. There were no differences in baseline characteristics of median images/case, age, disease duration, C-reactive protein, erythrocyte sedimentary rate, smoking status, and non-steroidal anti-inflammatory use in the two groups (p > 0.05 in all). Median CLS for combined asymptomatic IBD and symptomatic IBD were 8.04 and 18.95 respectively (p = 0.001). Median CLS in controls was 5.94. In CD, median CLS in asymptomatic and symptomatic groups were 8.42 and 17.67 respectively (p = 0.019). In UC, median CLS in asymptomatic and symptomatic groups were 6.87 and 22.