A264 CLINICAL, ENDOSCOPIC, AND HISTOPATHOLOGIC FEATURES OF GASTROINTESTINAL DISEASE IN COMMON VARIABLE IMMUNODEFICIENCY

• Published in: Journal of the Canadian Association of Gastroenterology Vol. 2; no. Supplement_2; pp. 519 - 520
• Main Authors: Khan, R, Habbal, M, Bukhari, A, Rumman, A, Scaffidi, M A, Al Ghamdi, S, Betschel, S, Grover, S C
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15.03.2019
• Subjects: Posters Of Distinction
• ISSN: 2515-2084; 2515-2092
• DOI: 10.1093/jcag/gwz006.263

Abstract Background Patients with common variable immunodeficiency (CVID) disorder are reported to have a significant burden of infectious and inflammatory gastrointestinal (GI) diseases. Currently, the clinical, endoscopic, and histopathologic characteristics of GI disease among CVID patients is not well described. Aims This study aims to characterize the clinical, endoscopic, and histopathologic profile of GI pathology in a large cohort of CVID patients from a tertiary care centre. Methods We included all CVID patients at St. Michael’s Hospital from January 1, 2000 to May 31, 2018. For each patient, we collected the age of CVID diagnosis, and age of onset of gastrointestinal symptoms. We collected the following clinical data at the time of onset of gastrointestinal symptoms: presence of abdominal pain, bowel movement changes, weight loss, nausea/vomiting, and bloating, history of gastrointestinal disease such as IBD or coeliac disease, treatments offered for GI symptoms, and gastrointestinal infections. We also collected endoscopic, histopathologic, and laboratory data, including immunoglobulin trough levels, at the date nearest to the onset of gastrointestinal symptoms, within three months. We used descriptive statistics to characterize patients with CVID, and compared patients with and without gastrointestinal symptoms using non-parametric tests for continuous variables and Fisher’s exact test for categorical variables. Results We included 95 patients with CVID. The mean age of patients at the time of CVID diagnosis was 38.2(±16.0). Fifty-three (56%) patients were female. Sixty-four (67%) patients had GI symptoms, with a mean age of onset for GI symptoms of 43.4(±15.1) years. The most common symptoms were bowel movement changes (n=55 [58%]) and abdominal pain (n=44 [46%]). Patients with GI symptoms were more likely to have anaemia (n=23 [36%] vs. n=3 [10%], p<0.05), iron deficiency (n=16 [25%] vs. n=2 [7%], p<0.05), and have received antibiotics for presumed GI infection (n=37 [58%] vs. n=0, p<0.05) and proton pump inhibitors for reflux (n=24 [38%] vs. n=3 [10%], p<0.05). The most common GI infections were Giardia lamblia (n=14 [15%]) and Clostridium difficile (n=4 [4%]). Forty-three (45%) patients with GI symptoms underwent colonoscopy, EGD, or both. The most common findings were inflammation, nodular lymphoid hyperplasia, reduced plasma cells, and increased intraepithelial lymphocytes. Conclusions This is the largest study on CVID patients in a North American setting. The majority of patients experienced GI symptoms. Future studies should study response to treatment for gastrointestinal disease among patients with CVID. Funding Agencies Ferring Scholarship Grant Award